Contractor / Customer Contact Information
Jobsite / Material Information
You must acknowledge that you are authorized and agree to certify.
* I, the undersigned, a duly authorized official or representative of the company or entity listed above, certify that the fill material requested to be delivered
to the Receiving Facility referenced above for use in reclamation meets the definition of Reclamation Fill (formerly “clean fill”) as stated below, and that
the fill material was derived from the property/project listed above.
Reclamation Fill means uncontaminated, nonwater-soluable, non-decomposable, inert solid material, to include soil, rock, stone, gravel, brick (no painted surfaces),
block and concrete (no painted surfaces), block and concrete containing metal internally (all metal shall be removed from the surface of the block and/or concrete
so that only rebar or other metals that are imbedded in the concrete remains), and used, uncontaminated asphalt.
No materials containing wood, plaster, metals, asphaltic substances (including, but not limited to shingles/roofing materials), brick, block, or concrete with
painted surfaces, tile, refractory brick, fly ash, dredged materials, or other materials that are not free or separate of materials meeting the definition of
waste shall be accepted. No materials which are post remediation or blended are acceptable.
Volumes of materials exceeding 3,000 yards from a single source must undergo laboratory analysis per the methodologies referenced in PA DEP Reclamation Fill
Technical Guidance 563-2000-301, and pre-approved by the Facility and Department of Environmental Protection -- Bureau of Mining and Reclamation -- Pottsville
District office before importation of the first load. Small sources (<3,000 yards) must be reviewed and self-certified by the facility or their agents prior to
import. please allow at least 24 hours for review.
H&K Group, Inc. has the right, in its sole discretion, to reject any materials with or without cause or for any reason or no reason
whatsoever.
Signature
THIS FORM MUST BE SUBMITTED TO THE RECEIVING FACILITY FOR REVIEW AND APPROVAL BEFORE THE FIRST LOAD OF MATERIAL MAY BE DELIVERED.
UNREVIEWED/UNAPPROVED MATERIALS WILL NOT BE PERMITTED TO TIP AT ANY FACILITY.
You must verify that you are not a robot.
TERMS & CONDITIONS
TERMS & CONDITIONS
ONLY RECLAMATION FILL MATERIALS CAN AND WILL BE ACCEPTED. Customer certifies that all materials brought to the Receiving Facility meet the reclamation fill standards established by the Pennsylvania Department of Environmental Protection; and all applicable site specific permit conditions and requirements.
H&K Group, Inc. reserves the right to require up-front laboratory analyses, at the Customer's expense, of materials prior to delivery to the Receiving Facility. H&K Group, Inc. will have the right to screen loads delivered and to collect samples as required by H&K Group, Inc, the Commonwealth of Pennsylvania Department of Environmental Protection and/or other governmental agencies. Materials deemed by H&K Group, Inc., in its sole discretion, not meeting the Reclamation Fill criteria will be rejected by H&K Group, Inc.
H&K Group, Inc. has the right to reject any Reclamation Fill materials for any reason or no reason whatsoever. Any materials rejected by H&K Group,Inc., shall be immediately removed from the property by the shipper. Any impacted (non- clean) materials or materials otherwise rejected by H&K Group, Inc. shall be reloaded onto the shipper's trucks at the Customer's cost and immediately removed from the property by the Customer.
Customer shall remain liable for any non-reclamation fill material brought to and/or disposed of at the property. Any non-reclamation fill material discovered after the Customer has left the property may be reloaded by H&K Group, Inc., and properly disposed of by H&K Group, Inc. at the Customer's cost. Any costs and expense, including attorney's fees, incurred by H&K Group, Inc. associated with the proper disposal of non-reclamation fill materials and any other materials affected thereby shall be paid by Customer immediately upon receipt of H&K Group, Inc.'s invoice. Customer agrees to pay for all materials disposed of at the property within 30 days of the first statement date, thereafter payment is past due. No FINANCE CHARGE is imposed if payment is received within 30 days of the first statement date. Customer agrees to pay a FINANCE CHARGE on amounts past due computed by periodic rate of 1 ½% per month, which is AN ANNUAL PERCENTAGE RATE of 19.6%, applied to the past-due balance after deducting current payments or credits.
Customer and driver of the truck agree that access to the property is provided to the driver and the Customer at their own risk and H&K Group, Inc. accepts no responsibility for any accidents, injury, harm or damage to Customer, driver and/or their equipment.
The Customer shall provide H&K Group, Inc., with a copy of the Reclamation Fill Certification covering the fill material it deposits at the Receiving Facility which certifies that the materials meet the definition of clean fill as described in PA DEP Technical Guidance Document No. 563-2000-301, and per the limitation and terms and conditions listed on the Reclamation Fill Source Information Form completed by Customer prior to delivery and will certify each load of materials delivered to the facility with an FP-001 provided by the facility.
Customer shall indemnify, defend and hold harmless the H&K Group, Inc., the owner of the Receiving Facility and their subsidiaries, affiliates and parent corporations, as applicable and their respective officers, directors, shareholders, lenders, employees, subcontractors and agents from and against any and all claims, suits, losses, liabilities, assessments, damages, fines, costs and expenses, including reasonable attorney's fees, and any inspection, testing, studies and/or analysis and the cost thereof, arising from, associated with or connected in any way to: (i) Customer and/or Customer's officers', directors', employees', agents', subcontractors', or representatives' activities, and/or operations; (ii) any materials transported to the Receiving Facility by Customer and/or Customer's employees, agents, haulers, transporters, subcontractors or representatives; (iii) any breach of this Agreement by Customer and/or any of Customer's officers, directors, employees, agents, subcontractors or representative; (iv) any negligence, negligent acts or intentional acts of the Customer, and/or Customers' employees, agents, haulers, transporters, subcontractors or representatives; (v) the collection, transportation and/or disposal of any materials transported to the Receiving Facility by Customer and/or Customer's employees, agents, haulers, transporters, subcontractors or representatives including, but not limited to materials originating from or connected in any way to the Property/Project of Origin; and (vi) any removal of any materials transported to the Receiving Facility by Customer and/or Customer's employees, agents, haulers, transporters, subcontractors or representatives. This indemnification and other obligations stated in this paragraph shall survive the termination of this Agreement.
Rights of Refusal/Rejection. The Customer shall inspect all materials to be transported to the Receiving Facility at the place(s) of collection and shall remove any and all non-reclamation materials. H&K Group, Inc., has the right, at H&K Group, Inc.'s sole discretion, to refuse or to reject after acceptance, any load(s) of materials delivered to the Receiving Facility including, but not limited to, if H&K Group, Inc., believes the Customer has breached (or is breaching) its representations, warranties, covenants or agreements hereunder, or any applicable federal, state or local laws, regulations, rules or orders, even if only a portion of such material load is unacceptable. H&K Group, Inc. shall have the right to inspect all vehicles, haulers and containers of materials. H&K Group, Inc.'s exercise, or failure to exercise, its rights hereunder shall not operate to relieve the Customer of its responsibilities or liability under this Agreement. The Customer shall be responsible for, and bear all reasonable expenses and damages incurred by H&K Group, Inc. and/or the owner of the Receiving Facility as a result of the transporting of any materials to the Receiving Facility including, but not limited to the reloading and removal of materials transported to and/or disposed of at the Receiving Facility. The Owner, may also, in its sole discretion, require the Customer to promptly remove unacceptable materials.
By their signature on Page 1 of this Reclamation Fill Source Approval Information Sheet, the Customer acknowledges and agrees to these terms and conditions on behalf of the driver and the Customer.
Approved H&K Group, Inc. Reclamation Fill Facilities
Blooming Glen Quarry
901 Minsi Trail, Perkasie, PA 18944
P: 215-257-5188 | F: 215-257-2357
Hours: M-F 7AM-3PM, Call to schedule outside of these times
Huckleberry Associates, Inc.
4359 Huckleberry Road, Allentown, PA 18104
P: 610-222-3042
By appointment only
Miller Quarry & Asphalt
887 Mill Creek Road, Rushland, PA 18956
P: 215-598-7801 | F: 215-598-0899
Hours: M-F 6AM-3:45PM, Call to schedule outside of these times
Pyramid Quarry
414 W. Knowlton Road, Media, PA 19063
P: 610-494-4722 | F: 610-494-1201
Hours: M-F 7AM-3PM, Call to schedule outside of these times
Sanatoga Quarry
394 South Sanatoga Road
Pottstown, PA19464
Hours: M-F 7AM to 3PM (Effective 12/11/23), Call to schedule outside of these times
TERMS & CONDITIONS
ONLY RECLAMATION FILL MATERIALS CAN AND WILL BE ACCEPTED. Customer certifies that all materials brought to the Receiving Facility meet the reclamation fill standards established by the Pennsylvania Department of Environmental Protection; and all applicable site specific permit conditions and requirements.
H&K Group, Inc. reserves the right to require up-front laboratory analyses, at the Customer's expense, of materials prior to delivery to the Receiving Facility. H&K Group, Inc. will have the right to screen loads delivered and to collect samples as required by H&K Group, Inc, the Commonwealth of Pennsylvania Department of Environmental Protection and/or other governmental agencies. Materials deemed by H&K Group, Inc., in its sole discretion, not meeting the Reclamation Fill criteria will be rejected by H&K Group, Inc.
H&K Group, Inc. has the right to reject any Reclamation Fill materials for any reason or no reason whatsoever. Any materials rejected by H&K Group,Inc., shall be immediately removed from the property by the shipper. Any impacted (non- clean) materials or materials otherwise rejected by H&K Group, Inc. shall be reloaded onto the shipper's trucks at the Customer's cost and immediately removed from the property by the Customer.
Customer shall remain liable for any non-reclamation fill material brought to and/or disposed of at the property. Any non-reclamation fill material discovered after the Customer has left the property may be reloaded by H&K Group, Inc., and properly disposed of by H&K Group, Inc. at the Customer's cost. Any costs and expense, including attorney's fees, incurred by H&K Group, Inc. associated with the proper disposal of non-reclamation fill materials and any other materials affected thereby shall be paid by Customer immediately upon receipt of H&K Group, Inc.'s invoice. Customer agrees to pay for all materials disposed of at the property within 30 days of the first statement date, thereafter payment is past due. No FINANCE CHARGE is imposed if payment is received within 30 days of the first statement date. Customer agrees to pay a FINANCE CHARGE on amounts past due computed by periodic rate of 1 ½% per month, which is AN ANNUAL PERCENTAGE RATE of 19.6%, applied to the past-due balance after deducting current payments or credits.
Customer and driver of the truck agree that access to the property is provided to the driver and the Customer at their own risk and H&K Group, Inc. accepts no responsibility for any accidents, injury, harm or damage to Customer, driver and/or their equipment.
The Customer shall provide H&K Group, Inc., with a copy of the Reclamation Fill Certification covering the fill material it deposits at the Receiving Facility which certifies that the materials meet the definition of clean fill as described in PA DEP Technical Guidance Document No. 563-2000-301, and per the limitation and terms and conditions listed on the Reclamation Fill Source Information Form completed by Customer prior to delivery and will certify each load of materials delivered to the facility with an FP-001 provided by the facility.
Customer shall indemnify, defend and hold harmless the H&K Group, Inc., the owner of the Receiving Facility and their subsidiaries, affiliates and parent corporations, as applicable and their respective officers, directors, shareholders, lenders, employees, subcontractors and agents from and against any and all claims, suits, losses, liabilities, assessments, damages, fines, costs and expenses, including reasonable attorney's fees, and any inspection, testing, studies and/or analysis and the cost thereof, arising from, associated with or connected in any way to: (i) Customer and/or Customer's officers', directors', employees', agents', subcontractors', or representatives' activities, and/or operations; (ii) any materials transported to the Receiving Facility by Customer and/or Customer's employees, agents, haulers, transporters, subcontractors or representatives; (iii) any breach of this Agreement by Customer and/or any of Customer's officers, directors, employees, agents, subcontractors or representative; (iv) any negligence, negligent acts or intentional acts of the Customer, and/or Customers' employees, agents, haulers, transporters, subcontractors or representatives; (v) the collection, transportation and/or disposal of any materials transported to the Receiving Facility by Customer and/or Customer's employees, agents, haulers, transporters, subcontractors or representatives including, but not limited to materials originating from or connected in any way to the Property/Project of Origin; and (vi) any removal of any materials transported to the Receiving Facility by Customer and/or Customer's employees, agents, haulers, transporters, subcontractors or representatives. This indemnification and other obligations stated in this paragraph shall survive the termination of this Agreement.
Rights of Refusal/Rejection. The Customer shall inspect all materials to be transported to the Receiving Facility at the place(s) of collection and shall remove any and all non-reclamation materials. H&K Group, Inc., has the right, at H&K Group, Inc.'s sole discretion, to refuse or to reject after acceptance, any load(s) of materials delivered to the Receiving Facility including, but not limited to, if H&K Group, Inc., believes the Customer has breached (or is breaching) its representations, warranties, covenants or agreements hereunder, or any applicable federal, state or local laws, regulations, rules or orders, even if only a portion of such material load is unacceptable. H&K Group, Inc. shall have the right to inspect all vehicles, haulers and containers of materials. H&K Group, Inc.'s exercise, or failure to exercise, its rights hereunder shall not operate to relieve the Customer of its responsibilities or liability under this Agreement. The Customer shall be responsible for, and bear all reasonable expenses and damages incurred by H&K Group, Inc. and/or the owner of the Receiving Facility as a result of the transporting of any materials to the Receiving Facility including, but not limited to the reloading and removal of materials transported to and/or disposed of at the Receiving Facility. The Owner, may also, in its sole discretion, require the Customer to promptly remove unacceptable materials.
By their signature on Page 1 of this Reclamation Fill Source Approval Information Sheet, the Customer acknowledges and agrees to these terms and conditions on behalf of the driver and the Customer.