Solid Waste Management Waste Tire Collection, Processing and Disposal Facility Annual Report
1. Year: ____________________ 2. Facility ID #: ______________________ 3. Facility Name: ________________________________________________________________
4. County: ______________________________________________________ 5. Physical Address: ______________________________________________________________
6. City, State, Zip: ________________________________________________ 7. Owner: ______________________________________________________________________
8. Mailing Address: _______________________________________________ 9. City, State, Zip ________________________________________________________________
10. Facility Phone #: ______________________________________________ 11. Facility Fax #: ________________________________________________________________
12. E-mail Address: _______________________________________________
14. Waste Tires Shipped from the Facility:
15: Tires on Site on
13. Waste Tires Received:
(Disposal facilities exempt from this portion)
January 1st:
(13a) Type
(13b) Quantity
(14a) Type
(14b) Quantity
(15a) Type
(15b) Quantity
(14c) Name and Location of Disposal Facility
of Tires
in tons
of Tires*
in tons
of Tires*
in tons
* Type of Tires should be identified as follows:
P - Processed Tires
WP - Whole Passenger Tires
TR - Truck Tires
OR - Off Road Tires
I hereby certify (or declare) that all information submitted in conjunction with this annual report is accurate to the best of my knowledge.
16. Signature: __________________________________________________________
Date: __________________________________________________________________
17. Print Name and Title: ___________________________________________________________________________________________________________________________
18. Maintain a copy for your records. Submit the original to: SCDHEC
Bureau of Land and Waste Management
Solid Waste Compliance
A copy of this annual report should be maintained
2600 Bull Street
at the facility for a minimum of 3 years.
Columbia, SC 29201
Page_____of_____
SOUTH CAROLINA DEPARTMENT OF HEALTH AND ENVIRONMENTAL CONTROL
DHEC 2718 (01/2011)
Solid Waste Management Waste Tire Collection, Processing and Disposal Facility Annual Report
1. Year: ____________________ 2. Facility ID #: ______________________ 3. Facility Name: ________________________________________________________________
4. County: ______________________________________________________ 5. Physical Address: ______________________________________________________________
6. City, State, Zip: ________________________________________________ 7. Owner: ______________________________________________________________________
8. Mailing Address: _______________________________________________ 9. City, State, Zip ________________________________________________________________
10. Facility Phone #: ______________________________________________ 11. Facility Fax #: ________________________________________________________________
12. E-mail Address: _______________________________________________
14. Waste Tires Shipped from the Facility:
15: Tires on Site on
13. Waste Tires Received:
(Disposal facilities exempt from this portion)
January 1st:
(13a) Type
(13b) Quantity
(14a) Type
(14b) Quantity
(15a) Type
(15b) Quantity
(14c) Name and Location of Disposal Facility
of Tires
in tons
of Tires*
in tons
of Tires*
in tons
* Type of Tires should be identified as follows:
P - Processed Tires
WP - Whole Passenger Tires
TR - Truck Tires
OR - Off Road Tires
I hereby certify (or declare) that all information submitted in conjunction with this annual report is accurate to the best of my knowledge.
16. Signature: __________________________________________________________
Date: __________________________________________________________________
17. Print Name and Title: ___________________________________________________________________________________________________________________________
18. Maintain a copy for your records. Submit the original to: SCDHEC
Bureau of Land and Waste Management
Solid Waste Compliance
A copy of this annual report should be maintained
2600 Bull Street
at the facility for a minimum of 3 years.
Columbia, SC 29201
Page_____of_____
SOUTH CAROLINA DEPARTMENT OF HEALTH AND ENVIRONMENTAL CONTROL
DHEC 2718 (01/2011)
Instructions for Completing DHEC 2718
SOUTH CAROLINA WASTE TIRE COLLECTION, PROCESSING AND DISPOSAL FACILITY’S ANNUAL REPORT FORM
PURPOSE: All Waste Tire collectors, processors and disposal facilities are
PROVIDE THE FOLLOWING INFORMATION FOR EACH CUSTOMER.
to use this form to report all activities during the last year.
ATTACH ADDITIONAL SHEETS IF NEEDED:
13. Provide the: a. Type of tires
EXPLANATION AND DEFINITION:
b. Quantity in tons of waste tires and/or processed tires hauled
All registered waste tire collectors, processors and disposal facility’s owners
from this location
must submit an annual report to the Department. This report is a summary of the
activities in the previous year. Such as:
14. Provide the: a. Type of tires
1. The type and number of waste tires received during year
b. Quantity of tires in tons
2. The type of waste tires, with name and location of where the tires were
c. Name and location of each disposal facility
shipped
3. And the type and quantity of waste tires on site January 1st of the current year
15. Provide the: a. Type of tires
b. Quantity of tires in tons stored on site January 1st
The waste tire collectors, processors and disposal facility must report all activities
during the previous year starting with March 1st of the previous year and ending
16. Sign and date the form.
with the last day of February in the current year. The Division of Compliance and
17. Print or type name and title of signer
Enforcement must receive this report, annually, prior to March 1st.
OFFICE MECHANICS AND FILING:
ITEM BY ITEM INSTRUCTIONS - Print or type:
18. Mail the Original, signed form to the address given.
1. The year covered by this report
Number each page then enter the total number of pages being sent. For
2. The waste tire collection / processing and disposal facility’s ID assigned by the
example, if 3 pages are sent, label the pages: page 1 of 3, page 2 of 3, and page
Department
3 of 3
3. The complete the name of the Facility submitting the annual report
4. The county where the Facility is located
It is the Waste Tire collectors, processors and disposal facilities responsibility
5. The address of the Facility’s location
to maintain the information summarized in the annual report for a minimum of
6. The city, state, and zip code for the Facility’s location
three (3) years. The information contained in this report may be subject to public
7. The name of the owner of the Facility
review through the Freedom of Information (FOI) Office.
8. The mailing address of the Facility if different than the location address
9. The city, state, and zip code for the Facility if different than the location
address
10. The Facility’s phone number
11. The Facility’s fax number
12. The Facility’s E-mail address
DHEC 2718 (01/2011)
ADVERTISEMENT