Oklahoma Department of Environmental Quality s23

Oklahoma Department of Environmental Quality Land Protection Division Used Tire Recycling Program

APPLICATION FOR BENEFICIAL REUSE

OAC 252:515-1-7. Beneficial Reuse (a) Upon request, and with supporting documentation, the DEQ may make a determination that a waste material is not a solid waste when it can be shown that the material is: (1) being used as an ingredient in an industrial process to make a product; (2) used as an effective substitute for commercial products; (3) being returned to the original process from which it is generated, without first being reclaimed. The material must be returned as a substitute for raw material feed-stock and the process must use raw materials as principal feed-stocks; or (4) in the possession of persons who actually possess the equipment necessary to process the material to comply with one of the above conditions. (b) The DEQ may also make a reuse determination on other proposals based upon an evaluation of the contemplated use of the material and potential effects on human health and the environment. (c) If waste is accumulated in anticipation of future markets or is stored in a quantity exceeding that which may be reasonably expected to be used or recycled within one (1) year, the material is regulated as a solid waste.

I. ATTACHMENTS: PROVIDE THE FOLLOWING INFORMATION ON SEPARATE PAGES, AND ATTACH THEM TO THIS FORM:

A. A copy of the deed or other legal description of the property on which the proposed project will be constructed.

B. A DETAILED NARRATIVE DESCRIPTION of the proposed project unless the civil engineering project has a set of plans signed and stamped by a registered professional engineer.

C. If the proposed project is to be in a floodplain, a waterway, or a wetland, written authorization of the project by the U.S. Army Corps of Engineers or other appropriate authorities.

D. An affidavit certifying that the proposed site complies with the applicable regulations of all local governing bodies having jurisdiction over the proposed facility, including planning, zoning, building, and code enforcement.

DEQ Form #515-181 II. GENERAL INFORMATION:

A. PROJECT TITLE: ______

B. APPLICANT INFORMATION:

MAILING ADDRESS

CITY, STATE, ZIP

TELEPHONE NUMBER E-MAIL ADDRESS

C. PROPERTY OWNER INFORMATION (if different):

MAILING ADDRESS

CITY, STATE, ZIP

D. BUILDER INFORMATION (if different):

MAILING ADDRESS

CITY, STATE, ZIP

E. LOCATION / PHYSICAL ADDRESS WHERE PROJECT WILL BE CONSTRUCTED: (If different from the mailing address):

DEQ Form #515-181 F. TEMPORARY STORAGE SITE INFORMATION (this section must be completed if tires will be stored prior to construction at a temporary storage site):

LOCATION / PHYSICAL ADDRESS

PROPERTY OWNER NAME (if different)

PROPERTY OWNER MAILING ADDRESS

CITY, STATE, ZIP

PROPERTY OWNER TELEPHONE PROPERTY OWNER E-MAIL ADDRESS

III. OPERATIONS:

A. ANTICIPATED START DATE WHEN TIRES BROUGHT TO PROJECT SITE:

B. PROJECTED COMPLETION DATE OF PROJECT:

C. ORIGINS OF USED TIRES TO BE USED:

D. THE NUMBER OF USED TIRES TO BE USED IN THE PROJECT:

E. METHOD OF STACKING (if applicable):

F. METHOD OF ANCHORING:

G. METHOD OF COVERING (if applicable):

H. METHOD OF FILLING TIRES:

DEQ Form #515-181 IV. CERTIFICATION:

THE UNDERSIGNED ATTESTS THAT THE INFORMATION PROVIDED UPON THIS REGISTRATION FORM, INCLUDING ALL ATTACHMENTS, IS TRUE AND CORRECT.

______SIGNATURE DATE

RETURN THIS FORM and the REQUIRED ATTACHMENTS TO: Bryce Hulsey Used Tire Recycling Program Land Protection Division Oklahoma Department of Environmental Quality 707 N Robinson PO Box 1677 Oklahoma City, OK 73101

RECEIVED DATE ______COMMENTS______

APPROVED DATE ______

______

DEQ Form #515-181