Drywall Declaration and Acknowledgement Form Driver's Name(Required) Company Name(Required) Vehicle Plate Number(Required) Address Where Drywall Originated(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Materials in the Load Include:(Required) Only date stamped material Non-date stamped or a mixture of date and non-date stamped board with analytical report that is less than 6 months old: Please list your date stamped materials: Please list your materials: Representation & Warranties(Required) I agree to these termsThe delivery and dumping of asbestos containing materials poses a serious health risk to workers and will result in significant damages to Salt Spring Garbage Service Ltd. Salt Spring Garbage Services Ltd is relying on the accuracy and the customers declaration in accepting drywall material for recycling. By signing this form, the customer agrees to accept liability for ALL costs incurred by Salt Spring Garbage Services Ltd (including business interruption losses and losses in profit) that result from an incorrect declaration regarding the origin and content of the material declared above and that minimum liability for making such an incorrect declaration will be a payment of $10,000 plus all clean-up costs. Salt Spring Garbage reserves the right to ban any customer from the facility for falsely/incorrectly providing wrong information.Signature(Required)Date(Required) MM slash DD slash YYYY Print Name(Required) First Last Driver's License Number(Required)
