WASTE TIRE GENERAL PERMIT
NOTIFICATION(TP-6)
Pursuant to Regulation 14, Waste Tire Program, to obtain coverage under a general permit for the operation of a waste tire collection and/or waste tire processing facility (small and/or mobile), anapplicant shall submit the following information to the Department:
- Application Information
Type of Facility: / Waste Tire Collection Center / Other:
Waste Tire Processing Facility: Baler Shredding Chopping Cutting
Type of Application:
(Check One) / Proposed New Facility / Existing Unpermitted Facility
Date Operation To Begin: / Date Operation Began
Max. Quantity of Waste Tires Stored or To Be Stored Onsite / Max. Quantity of Waste TiresProcessed or To Be Processed Monthly
- Owner and Operator Information
Name of Property Owner: / TelephoneNbr.:
Fax Nbr.:
Mailing Address: / Manager and/or
Owner Name:
City/State/Zip: / E-Mail:
Type Of Owner: / Individual Partnership Corporation Government Other:
Company Name of Site Operator: / Operator Name:
Operator Address: / Telephone Nbr.:
City/State/Zip: / E-Mail:
Type Of Operator: / Individual Partnership Corporation Government Other:
- Site Information
Site Name: / County:
Site Address: / Telephone Nbr.:
City/State/Zip: / LAT/LONG:
Section, Township and Range:
Site Directions from Major Intersection:
Describe how and where the waste tires, processed tires, and residuals from processing will be disposed(Processed tires must be expressed in tons, assuming auto tires weigh 22.5 lb. and truck tires weigh 120 lb.)
If not to be disposing of processed tires or processing residuals on the facility site, indicate the permitted solid waste management facility where processed tires or residuals will be disposed:
Facility Name: / Site
Telephone Nbr.:
Street Address: / County:
City/State/Zip: / E-mail:
4. QuantitiesofWasteTires and ProcessedTiresStored at Siteand/orDisposed
Note:Processedtiresmustbeexpressedintons,assumingauto tires weigh 22.5 lbs., truck tires weigh 120 lbs., and average of all scrap = 46 lbs.
CurrentStorage(Tons) / StorageArea(SquareFt.) / MaximumStorage(Tons)
WasteTires:
ProcessedTires:
Totals:
Ifnottobedisposingof processedtiresorprocessingresidualonthefacilitysite,indicatethepermittedsolidwaste
managementfacilitywhereprocessedtiresorresidualswillbedisposed:
FacilityName: / Site
TelephoneNbr.:
StreetAddress: / County:
City/State/Zip: / E-mail
Iftobedeliveringprocessedtirestoanother facility or end-user,describetheexistingorproposedmarket(s)forprocessed tires:
5a. Required Attachments for Waste Tire Collection Centers
1 / Letter of notification to fire protection authority
2 / General Permit fee of $25.00 for waste tire collection center
5b. RequiredAttachments for Waste Tire Processing Facilities
(Includethefollowingitemsinthewaste tire processing facility applicationorgiveanexplanation,iftheyarenotapplicable.)
NOTE:Allmaps, plansheets,drawings,isometrics, cross sections,or aerialphotographs shall belegible;besignedandsealedby a
registeredprofessionalengineer responsiblefortheir preparation; beofappropriatescaletoshowclearly allrequireddetails;benumbered, referenced tonarrative, titled,havealegendofsymbols used, containhorizontalandvertical scales,(whereapplicable),andspecifydraftingor originationdates; and useuniformscalesasmuchaspossible, containanortharrow,anduseNationalGeodetic Vertical Datum(NGVD)for all elevations. For renewals under a new waste tire general permit, previously approved documents may be submitted as long as there have been no modifications and the plans remain in compliance with Regulation 14 and other regulations.
1. FacilityDesign
a. / Atopographicorsectionmapof thefacility,includingthesurroundingareaforonemile,nomorethanoneyear
old,showinglanduseand zoningwithinonemileof thefacility
b. / Evidencethatthefacilityisinconformancewithlocalzoning
c. / Aplotplanof thefacilityon ascaleof notlessthanone inchequals200feet.At aminimum,theplotplanshall include:
a) The facility design, includingthelocationandsizeof all storageandprocessingareas forwaste tires,processedtires, andresiduals fromprocessing;
b) Allwetlands andwater bodies;
c) Stormwatercontrolmeasures,includingditches,dikesand other structures;
d) Legalboundaries,easements andrightof ways;
e) Locationofallwells, operatingandabandoned / f) Allstructuresandbuildingsthatareorwillbeconstructedatthe facility; include thoseusedinstorageand processingoperations;
g) Allareasused forloadingandunloading;
h) Allaccessroadsandinternalroads, includingfirelanes;
i) Location of all fences, gates, and other access control measures;and
j) Locationofallprocessedtireor residualdisposalareas.
2. FacilityOperation
a. / Descriptionof thefacility’soperation,includinghowwastetiresandprocessedtireswillbecollected,storedand
processed
b. / Descriptionof howeachof thestoragerequirementsin Regulation14,WasteTireProgram,willbe met
c. / Copyof theemergencypreparednessmanualforthefacility
d. / Copyof thefiresafetysurvey
e. / Descriptionof how75%of theannualaccumulationof wastetiresandprocessedtireswillbe processedand
removedfordisposalorrecycling
f. / CompletedclosureplanforthefacilityasrequiredbyRegulation14,WasteTireProgram
g. / ProofoffinancialresponsibilityasrequiredbyRegulation14,WasteTireProgram
h. / Permitfee($100) requiredbyRegulation14,WasteTireProgram
6. Certification
To the best of my knowledge, I certify the above information provided is true and correct. I am awarethat statements madein thisformandattached information are part of anapplicationfor awastetirefacility permit fromtheArkansasDepartmentof EnvironmentalQuality andcertifiesthat theinformation inthis application istrue, correct,and completetothe best ofhis/her knowledgeand belief. Further,the undersignedagreestocomplywiththe provisionsof Act749, Regulation 14,Arkansas statutes, andallrules andregulationsoftheDepartment. It isunderstoodthatthepermitcoverage isnot transferable,andtheDepartmentwill benotified prior tothesaleor legaltransferofthefacility.
Signature of Authorized Agent / Print Authorized Agent Name and Title / Date
7. Professional EngineerRegisteredinArkansas
(Required for waste tire processing facilities)
Thisistocertifythattheengineeringfeaturesofthiswastetire processingfacilityhavebeen designedand/orexaminedbyme andfoundtoconformto engineeringprinciplesapplicabletosuchfacilities.Inmyprofessionaljudgment,thisfacility,when properlymaintainedandoperatedwillcomplywith allapplicablestatutesoftheStateofArkansasandrulesoftheDepartment.
It isagreedthattheundersignedwill providethe applicantwithasetof instructionsfor proper maintenanceandoperationofthe facility.
Signature:
PrintedNameandTitle
MailingAddress:
City/State/Zip:
TelephoneNumber:
ArkansasRegistrationNumber and Seal:
Form TP6
Authority: A.C.A §8-9-403
Page 1 of 4
Rev. 09-25-2013 / Return Completed Form and Attachment(s) to:
ADEQ SWMD – Waste Tire Program
5301 Northshore Drive – North Little Rock, AR 72118
Phone: (501) 682-0585 | Fax (501) 682-0880