Free 52716.pdf - Indiana

ANNUAL TIRE SUM M ARY: W ASTE TIRE STORAGE SITE/W ASTE TIRE PROCESSING OPERATION
S tate Form 52716 (R /8-08) Indiana D epartm ent of Environm ental M anagem ent

INSTRUCTIONS:

1. Use this form to report the amount of waste tires managed by a registered waste tire storage site or waste tire processing operation during the previous calendar year as required by IC 13-20-13-5(1) and 329 IAC 15-3-20(b). 2. Print or type all requested information. Use the same unit of measurement for all amounts reported. 3. Use the conversion factors on the back of the form. 4. When completed, return this form to the following address by January 31 of the year following the year reported: IDEM Office of Land Quality, Solid Waste Permits Section, 100 North Senate Avenue, Indianapolis, IN 46204-2251 5. For more information, contact IDEM's Office of Land Quality, Solid Waste Permits Section, at (317) 232-0066.

Calendar year reported (January 1 through December 31): Facility information:
Facility Name: Address: City: Contact Person: State: Registration Number:

20_____

IN

Zip Code:

Telephone:

Unit of measure used in this report:

cubic yards

tons

Amount of waste tires received at this facility during the reporting year: Amount of waste tires disposed of during the reporting year: ! Landfill - solid waste ! Landfill - alternative daily cover ! Civil engineering ! Tire-derived fuel ! Reuse without processing ! Other use Total amount of waste tires disposed of (total of all disposal methods): Amount of waste tires remaining on December 31 of the reporting year: I certify, under penalty of perjury as provided in IC 35-44-2-1, that to the best of my knowledge this information is true and accurate, and that I am an authorized agent of the registrant. ____________________________
Name

______________________________
Signature

_______________
Date

CONVERSION FACTORS (Rubber Manufacturers Association): W hole Scrap Tire Volume and W eight: volume passenger tires: light truck tires: truck tires: 1 passenger tire = 2.7 cubic feet 10 passenger tires = 27 cubic feet (1 cubic yard) 1,000 passenger tires = 2,700 cubic feet (100 cubic yards) 1 light truck tire = 2.7 cubic feet 10 light truck tires = 1 cubic yard 1,000 light truck tires = 2,700 cubic feet (100 cubic yards) 2 truck tires = 1 cubic yard 1 truck tire = 13.5 cubic feet 1,000 truck tires = 13,500 cubic feet (500 cubic yards) weight 1 passenger tire = 20 pounds 100 passenger tires = 1 ton (2,000 pounds) 1,000 passenger tires = 10 tons (20,000 pounds) 1 light truck tire = 30 pounds 100 light truck tires = 1.5 tons (3,000 pounds) 1,000 light truck tires = 15 tons (30,000 pounds) 1 truck tire = 100 pounds 20 truck tires = 1 ton (2,000 pounds) 1,000 truck tires = 50 tons (100,000 pounds)

W hole Scrap Tire Density: type of tire passenger/light truck tires truck tires Shredded Scrap Tire Density: type of shred single pass 2 inch shred 1½ inch shred 10 mesh 20 mesh 30 mesh 40 mesh 80 mesh loosely packed* 550-600 lbs/yd3 850-900 lbs/yd3 1,000-1,100 lbs/yd3 densely packed* 1,220-1,300 lbs/yd3 1,350-1,400 lbs/yd3 1,500-1,600 lbs/yd3 loosely packed* 27.5-30 tires/yd3 42.5-45 tires/yd3 50-55 tires/yd3 densely packed* 61-65 tires/yd3 67.5-70 tires/yd3 75-80 tires/yd3 loosely packed* 10/yd (100/10yd ) 2/yd3 (20/10yd3)
3 3

densely packed* 50/yd3 (500/10yd3) 10/yd3 (100/10yd3)

29 lbs/ft3 or 783 lbs/yd3 28 lbs/ft3 or 756 lbs/yd3 28 lbs/ft3 or 756 lbs/yd3 27 lbs/ft or 729 lbs/yd
3 3

39 (39.15) tires/yd3 38 (37.8) tires/yd3 38 (37.8) tires/yd3 36 (36.45) tires/yd3 34 (33.75) tires/yd3 35 (35.1) tires/yd3

25-26 lbs/ft3 or 675-702 lbs/yd3