Free 48561.pdf - Indiana

Office of Pollution Prevention and Technical Assistance WASTE TIRE RECYCLING GRANT PROGRAM 402 West Washington Street, W041 P.O. Box 7095 Indianapolis, IN 46207-7095 State Form 48561 (R3/8-04) Indiana Department of Environmental Management Internet: http://www.in.gov/idem/oppta/recycling/grants/tires/index.html INSTRUCTIONS: For assistance call the Office of Pollution Prevention and Technical Assistance (800-988-7901). Please print or type. Grant funding is not available for waste tire processing equipment unless an established end use is demonstrated.

WASTE TIRE GRANT APPLICATION INDIANA WASTE TIRE GRANT RECYCLING PROGRAM

SECTION 1 Program administrator (contact person) Mr. Ms. Title: Official name of agency or organization: Federal ID number: Address: City: SECTION 2

APPLICANT INFORMATION Phone: Fax: E-mail: County (ies):

ZIP code + 4: PROJECT SUMMARY Please shade area served or attach map showing area to be served.

SECTION 3 Target number of tires to be recycled: (per year, best estimate based on projections) Total project cost: SECTION 4 (Check the appropriate box) Business School County City SECTION 5 SWMD 12/31 cash balance: $ $

GRANT DATA Source of tires: Tire dump recovery? $ TYPE OF APPLICANT Solid Waste Management District University Non-profit Town SOLID WASTE MANAGEMENT DISTRICTS ONLY Yes $ No Funds requested:

Match funds provided

SECTION 6 Civil Engineering Research and Development SECTION 7

Report the cash balance as reported on State Board of Accounts, Form # SWMDAR-1, Part 1, Column F, Solid Waste Management Fund. TYPE OF PROJECT Tire-derived Fuel Recreational Field Use SIGNATURE BLOCK Education

I certify that submission of this application has been duly authorized by the governing body of the entity and that I am legally authorized by the governing body to sign the application. Signature of applicant Printed name Date (month, day, year)

INSTRUCTIONS: Round amounts up to whole dollars. A dollar for dollar cash match is required for equipment purchases. If grant is awarded, an approved budget page will be included in Exhibit A of the grant agreement. SECTION 8 PROPOSED BUDGET Grant Request Personnel $ $ $ (no state funds available for personnel expenses) $ $ $ $ $ $ $ $ $ Cash Match In-Kind Total

Equipment and Project Costs $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $

On-going Operating/Program Costs $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $

Contractor/Professional Fees $ $ $ $ $ $ $ $ $ $ $ $

Other Costs $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ Enter column totals in boxes below. $ $ $ $ $ $ $

INSTRUCTIONS: Applications are evaluated based on the responses to the questions listed in numbers 1-5. Each response must be complete and numbered; please attach the application question responses to the cover page, proposed budget, and any other applicable materials being submitted.

SECTION 9 1) Project Description a) b) c) d) e) f) g) 2) Describe the proposed project and partners involved.

APPLICATION QUESTIONS

Describe the goals and objectives of the project, including a general description of how the project is structured. Provide the location of the project, and explain why this location was chosen. Why is grant funding needed for this project? Describe any financial constraints or other factors that contribute to the need for grant funding. Demonstrate the benefits of waste tire diversion specific to your area, with specific attention to any environmental or health and safety threats the project will address. Will this project address an IDEM compliance issue at the location of the project or the source of the waste tires? Provide anticipated project timeline (e.g., activity occurs months 1-3, months 4-6, months 7-9, etc.). Note goals to be achieved at each milestone.

Waste Diversion a) b) Describe how this project will divert waste tires from disposal. Provide a material flow plan for this project. Include the following information. i) ii) iii) iv) c) d) e) How will waste tires be used in this project? State whether project focuses on clean waste tire sources or existing tire dump diversion. How many waste tires will this project use? How will tires be processed, and by whom?

Provide the company name, address and phone number for all contractors to be used. Document the background, training, and technical expertise for key project personnel (either applicant or contractor) through resumes, references, background statements, etc. Will the waste tires used in the project be acquired in Indiana? If they will be acquired outside Indiana, explain why.

3)

Marketing/Program Plan a) b) c) d) e) f) g) Describe your Marketing Profile / Recycling and Reuse Profile. Describe industry-wide market trends and state and local market conditions for waste tire products Outline how the project will increase the marketability of waste tires within Indiana. Project (estimate) size and growth rate for the recycled waste tire product or field/reuse application in Indiana. Describe, in detail, your current and future marketing plans, or your recycling / reuse market. How will you evaluate the success of the project? Outline your evaluation plan, including the criteria you will measure and the person who will be responsible for the evaluation. Describe the information or work product that will be provided to the state that might be transferable to other locations and future projects.

4)

Project sustainability a) To demonstrate project sustainability, please provide the following: i) Letter (or resolution, if applicant is a unit of government or a solid waste management district) committing both the cash and in-kind match for the project. ii) iii) b) c) d) Commitment letters from all project partners demonstrating both initial and ongoing material and monetary resources pledged. Upper management support letters (e.g., board, mayor, council, etc.)

Describe personnel investment, including number of hours committed to project (new and current resources). Describe your equipment maintenance plan and explain how you will fund replacement equipment, if requesting equipment funding. Describe all cost and program efficiencies realized by project implementation (e.g. estimated economic efficiencies, program costs per ton collected, and population serviced by project).

5)

Budget Please explain all line items (grant requests, cash, and in-kind matching columns) noted on the budget page of the application. Quotes and spec sheets are required for all purchases. Note that all grant funded line items on budget page require dollar-for-dollar cash or in-kind match; equipment purchases and lease or rental fees require dollar-for-dollar cash match.

SECTION 10 BENEFICIAL REUSE INFORMATION INSTRUCTIONS: this information is required for review of beneficial reuse application by IDEM's Office of Land Quality. This series of questions must be addressed by all projects and included with your grant application/request. a) Project location: Include a current county highway or a U.S. Geological Survey topographic map showing the location of the project. Include a current land deed/plat map showing the site within the property boundaries. Identify the property owner by name and mailing address. b) c) Information on the number and source of tire: Indicate how many waste tires the construction requires, where the tires will be obtained and the total to be stored on the site at one time. Project description: The description must demonstrate that the proposal is a legitimate use and is not merely a means to dispose of waste material. A copy of a published article or a research paper on the type of construction may be sufficient. If available, engineering specifications and/or project-specific plans are excellent ways to support the use. Storage of waste tires: Describe how the waste tires will be stored on site. The tires must not be allowed to collect rainwater possibly creating a breeding site for mosquitoes. Access lanes must be provided between tire piles to allow local fire control equipment on to the site. Following are the minimum requirements for storage in accordance with the number of tires: Less than 1000 tires: A signed statement that the local fire department with jurisdiction has been notified that tires will be stored must be provided. More than 1000 tires: If storage will be less than three (3) months, a contingency plan per 329 IAC 15-3-18 must be provided. If approval is granted for the use, the site must comply with both 329 IAC 15-3-18 and 15-3-19. If storage will be more than three (3) months, a full waste tire storage registration must be submitted to IDEM. The facility must keep the registration current and comply with all registration conditions until the tires are completely reused. e) Disposal of unusable or excess tires: The property owner is ultimately responsible for removal and disposal of unwanted tires and other trash or rubbish dumped at the site. Include your plans for insuring proper disposal of excess or unusable tires and other solid waste(s). It is recommended that you limit vehicle access to the site to discourage unauthorized dumping.

d)

SECTION 11 GENERAL APPLICATION INFORMATION IDEM does not issue verbal approvals for beneficial use of waste tires. Please send your written request for approval with the information provided in Section 10 to IDEM's Office of Land Quality, Technical Compliance Section prior to application submittal, if possible. Grant funded applications involving beneficial reuse must have IDEM pre-approval for the reuse prior to a grant award. Questions regarding beneficial reuse waivers may be directed to the Office of Land Quality, Technical Compliance Section staff at 317-308-3103. Submission of an application does not guarantee funding. Applications become the property of the Indiana Department of Environmental Management and will not be returned. Before completing an application, please read the Waste Tire Recycling Grant Policies thoroughly. These policies describe the criteria used to evaluate applications and explain the grant approval process. Please contact the Office of Pollution Prevention and Technical Assistance if you have questions regarding the program. Please complete all sections of this application and return it to the address below. Waste Tire Grant Manager Indiana Department of Environmental Management Office of Pollution Prevention and Technical Assistance 402 W. Washington Street, W041 P.O. Box 7095 Indianapolis, IN 46207-7095 For additional information contact OPPTA's Waste Tire Grant Manager at 317-233-9341 or 800-988-7901.