160-123 Main Street (Box 50)
Winnipeg, Manitoba R3C 1A5
PHONE: (204) 945-3268
FAX: (204) 945-1211
WASTE REDUCTION AND RECYCLING SUPPORT (WRARS) PROGRAM
LANDFILL LEVY REMITTANCE FORM
FORM A: LANDFILLS WITH WEIGH SCALES (Measured Waste) WRARS REGISTRATION NUMBER:
CONTACT INFORMATION
Landfill(s) Owner:
Authorized Contact:
Title:
Address:
Town/City:
Phone Number:
Email Address:
Postal Code:
Fax Number:
Web Site:
REPORTING PERIOD (YEAR 20
)
January 1 to June 30
July 1 to December 31
Construction,
Renovatrion
& Demolition
Facility Name
Industrial,
Commercial
&
Institutional
Facility Type
Residential
For each disposal facility owned, please identify the facility class and the source and amount of waste
disposed in the landfill for the appropriate reporting period. If applicable, disposal amounts must include
the amount of waste burned on site and at Waste Transfer Stations.
Approximate % of waste disposed Total Waste Disposed
by source
(Tonnes)
Landfill Class:
1
2
3
Landfill Class:
1
2
3
TOTAL WASTE DISPOSED (TONNES)
TOTAL WRARS LEVY REMITTED (Total Tonnes of Waste Disposed x $10) $
Please make cheques payable to: Green Manitoba
Please send the cheque together with the completed form.
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Waste Quantity
Weighed
160-123 Main Street (Box 50)
Winnipeg, Manitoba R3C 1A5
PHONE: (204) 945-3268
FAX: (204) 945-1211
Please list all Municipalities using the landfill(s), including populations served:
1.
2.
3.
4.
5.
Please list other landfills used by the municipality, including the population served by each landfill:
1.
2.
3.
4.
5.
___________________
DECLARATION
The WRARS Levy is equal to $10 times the total tonnes of waste disposed at a Class 1, Class 2 or Class 3 landfill site
and must be paid to Green Manitoba for each six (6) month period, as set out in the Waste Reduction and Recycling
Support (WRARS) Program Guide. The conditions of this agreement include:
1. Records must be maintained on file for a five (5) year period.
2. Records will be provided to an agent of Green Manitoba upon request.
3. All reported landfill data may be subject to an independent audit on a periodic basis.
The landfill owner understands the requirements for the WRARS Program and agrees to cooperate
with all WRARS policies and procedures.
Authorized Contact Signature
Date
Send Completed Form to:
WRARS Program
c/o Green Manitoba
160-123 Main Street (Box 50)
Winnipeg, MB R3C 1A5
Fax: 204-945-1211
Phone: 204-945-2041
Email: Jennifer.Lusk@gov.mb.ca
For Green Manitoba Use Only
Date Processed:
Approved By:
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