DHEC Form 2738 "South Carolina Waste Tire Manifest Used for Waste Tires Hauled to a Waste Tire Collection Facility, Landfill or Processing Facility" - South Carolina

DHEC Form 2738 or the "South Carolina Waste Tire Manifest Used For Waste Tires Hauled To A Waste Tire Collection Facility, Landfill Or Processing Facility" is a form issued by the South Carolina Department of Health and Environmental Control.

Download a PDF version of the DHEC Form 2738 down below or find it on the South Carolina Department of Health and Environmental Control Forms website.

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Download DHEC Form 2738 "South Carolina Waste Tire Manifest Used for Waste Tires Hauled to a Waste Tire Collection Facility, Landfill or Processing Facility" - South Carolina

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South Carolina Waste Tire Manifest
Used for Waste Tires Hauled to a Waste Tire Collection Facility,
Landfill or Processing Facility
Must be permitted and/or approved by the S.C. Department of Health and Environmental Control (DHEC)
or on the Waste Tire Rebate List
PART 1: CERTIFICATION BY RETAILER OR GENERATOR
Retailer/Generator: __________________________________________________________________________________________________________________________
Owner: ____________________________________________________________________________________________________________________________________
Business Address: __________________________________________________________________________________________________________________________
City: _________________________________________________________ State: ________________________________Zip: ___________________________________
Telephone: ___________________________________________________________ Fax: ________________________________________________________________
Amount of Waste Tires Transported
Total Number of Tires: _____________________________________________ Number of Passenger Tires: ________________________________________________
Number of Truck Tires: ____________________________________________ Number of Off-road Tires: __________________________________________________
Destination of Waste Tires: ___________________________________________________________________________________________________________________
South Carolina-approved Waste Tire Collection Facility, Landfill or Processing Facility
I hereby certify that the above indicated waste tires were collected in the normal course of business in _________________________ County, _______________
State of _________________________ and are destined to be transported to the facility indicated above.
Signed: _______________________________________________________________________________________Date: ________________________________________
(Retailer/Generator or Authorized Representative)
PART 2: CERTIFICATION BY REGISTERED WASTE TIRE HAULER
Waste Tire Hauler: __________________________________________________________________________________________________________________________
Waste Tire Hauler Registration Number: _______________________________________________________________________________________________________
Business Name: ____________________________________________________________________________________________________________________________
Business Address: __________________________________________________________________________________________________________________________
City: _________________________________________________________ State: ________________________________Zip: ___________________________________
County:__________________________________________________________ Telephone: _______________________________________________________________
S.C. Sales Tax Number: _____________________________________________________________________________________________________________________
Number of Tires Listed Above Selected by the Waste Tire Hauler as Used Tires: _______________________________________________________________
Storage Address of Used Tires: _______________________________________________________________________________________________________________
City: _________________________________________________________ State: ________________________________Zip: ___________________________________
I hereby certify that the waste tires received from the retailer/generator (see Part I of this form) will be delivered to the destination designated by the retailer/
generator and that the completed and signed manifest will be returned to the retailer generator within 30 days from this date. I also certify that I will retain a
copy of the manifest for my records per Regulation 61-107.3.
Signed: _______________________________________________________________________________________Date: ________________________________________
(Waste Tire Hauler or Authorized Representative)
PART 3: CERTIFICATION BY WASTE TIRE COLLECTION FACILITY, LANDFILL OR PROCESSING FACILITY
(Must be permitted and/or approved by DHEC or on the Waste Tire Rebate List)
Waste Tire Collection Facility, Landfill or Processing Facility: _____________________________________________________________________________________
Owner/Operator: ___________________________________________________________________________________________________________________________
Business Address: __________________________________________________________________________________________________________________________
City: _________________________________________________________ State: ________________________________Zip: ___________________________________
County:__________________________________________________________ Telephone: _______________________________________________________________
S.C. Permit Number (if applicable): ____________________________________________________________________________________________________________
I hereby certify that this facility is permitted and /or approved by DHEC to receive waste tires from South Carolina and has received the following amount of
waste tires
Amount of Waste Tires Received
Total Number of Tires: _____________________________________________ Number of Passenger Tires: ________________________________________________
Number of Truck Tires: ____________________________________________ Number of Off-road Tires: __________________________________________________
Signed: _______________________________________________________________________________________Date: ________________________________________
(Waste Tire Collection Facility, Landfill or Processing Facilities Authorized Representative)
Continuity Check
Passenger Tires: 22.5 lbs. each
Commercial Tires: 120 lbs. each
Mix Load of Tires: 37 lbs. (average)
Approximately
89 per ton
17 per ton
54 per ton
SOUTH CAROLINA DEPARTMENT OF HEALTH AND ENVIRONMENTAL CONTROL
Page 1 of 2
DHEC 2738 (8/2014)
South Carolina Waste Tire Manifest
Used for Waste Tires Hauled to a Waste Tire Collection Facility,
Landfill or Processing Facility
Must be permitted and/or approved by the S.C. Department of Health and Environmental Control (DHEC)
or on the Waste Tire Rebate List
PART 1: CERTIFICATION BY RETAILER OR GENERATOR
Retailer/Generator: __________________________________________________________________________________________________________________________
Owner: ____________________________________________________________________________________________________________________________________
Business Address: __________________________________________________________________________________________________________________________
City: _________________________________________________________ State: ________________________________Zip: ___________________________________
Telephone: ___________________________________________________________ Fax: ________________________________________________________________
Amount of Waste Tires Transported
Total Number of Tires: _____________________________________________ Number of Passenger Tires: ________________________________________________
Number of Truck Tires: ____________________________________________ Number of Off-road Tires: __________________________________________________
Destination of Waste Tires: ___________________________________________________________________________________________________________________
South Carolina-approved Waste Tire Collection Facility, Landfill or Processing Facility
I hereby certify that the above indicated waste tires were collected in the normal course of business in _________________________ County, _______________
State of _________________________ and are destined to be transported to the facility indicated above.
Signed: _______________________________________________________________________________________Date: ________________________________________
(Retailer/Generator or Authorized Representative)
PART 2: CERTIFICATION BY REGISTERED WASTE TIRE HAULER
Waste Tire Hauler: __________________________________________________________________________________________________________________________
Waste Tire Hauler Registration Number: _______________________________________________________________________________________________________
Business Name: ____________________________________________________________________________________________________________________________
Business Address: __________________________________________________________________________________________________________________________
City: _________________________________________________________ State: ________________________________Zip: ___________________________________
County:__________________________________________________________ Telephone: _______________________________________________________________
S.C. Sales Tax Number: _____________________________________________________________________________________________________________________
Number of Tires Listed Above Selected by the Waste Tire Hauler as Used Tires: _______________________________________________________________
Storage Address of Used Tires: _______________________________________________________________________________________________________________
City: _________________________________________________________ State: ________________________________Zip: ___________________________________
I hereby certify that the waste tires received from the retailer/generator (see Part I of this form) will be delivered to the destination designated by the retailer/
generator and that the completed and signed manifest will be returned to the retailer generator within 30 days from this date. I also certify that I will retain a
copy of the manifest for my records per Regulation 61-107.3.
Signed: _______________________________________________________________________________________Date: ________________________________________
(Waste Tire Hauler or Authorized Representative)
PART 3: CERTIFICATION BY WASTE TIRE COLLECTION FACILITY, LANDFILL OR PROCESSING FACILITY
(Must be permitted and/or approved by DHEC or on the Waste Tire Rebate List)
Waste Tire Collection Facility, Landfill or Processing Facility: _____________________________________________________________________________________
Owner/Operator: ___________________________________________________________________________________________________________________________
Business Address: __________________________________________________________________________________________________________________________
City: _________________________________________________________ State: ________________________________Zip: ___________________________________
County:__________________________________________________________ Telephone: _______________________________________________________________
S.C. Permit Number (if applicable): ____________________________________________________________________________________________________________
I hereby certify that this facility is permitted and /or approved by DHEC to receive waste tires from South Carolina and has received the following amount of
waste tires
Amount of Waste Tires Received
Total Number of Tires: _____________________________________________ Number of Passenger Tires: ________________________________________________
Number of Truck Tires: ____________________________________________ Number of Off-road Tires: __________________________________________________
Signed: _______________________________________________________________________________________Date: ________________________________________
(Waste Tire Collection Facility, Landfill or Processing Facilities Authorized Representative)
Continuity Check
Passenger Tires: 22.5 lbs. each
Commercial Tires: 120 lbs. each
Mix Load of Tires: 37 lbs. (average)
Approximately
89 per ton
17 per ton
54 per ton
SOUTH CAROLINA DEPARTMENT OF HEALTH AND ENVIRONMENTAL CONTROL
Page 1 of 2
DHEC 2738 (8/2014)
INSTRUCTIONS FOR COMPLETING DHEC 2738
South Carolina Waste Tire Manifest
PURPOSE:
Provide the name of the county where the business is located
or, if it is not a business, the county where the person generating
This form is used to track and certify that waste tires received
the waste tires is located.
from a retailer/generator of waste tires are delivered to a waste tire
collection, facility, landfill or processing facility that is permitted and/
Enter the County or Municipal Business License and the S.C.
or approved by DHEC or listed on the DHEC Waste Tire Rebate List.
Sales Tax Number if you have them. If not, enter N/A.
List the number of used tires selected and removed from the
EXPLANATION:
waste tires.
Any person engaged in transporting waste tires in South Carolina
Provide the number of waste tires to be transported by type
for the purpose of storage, disposal or processing must use a S.C.
(passenger, truck, off-road). Also provide the total number of
Waste Tire Manifest to track and certify the movement of waste tires
waste tires to be transported.
from the retailer/generator to the waste tire collection facility, landfill
or processing facility. The manifest supports Regulation 61-107.3,
List the name, address and telephone number of the waste
Section F.5, that requires waste tire haulers to record and maintain for
tire collection facility, landfill or processing facility that will
three years the following:
receive the waste tires.
1.
quantity of tires hauled;
Enter the county and state in the certification statement and
sign and date it.
2.
where and from whom the tires were hauled; and
3.
where the tires were deposited.
Part 2: Certification by Waste Tire Hauler – The waste tire hauler
shall complete Part 2 of the form. If the waste tire hauler removes
Finally the manifest certifies transportation of waste tires from
tires from those received from the retailer/generator for the purpose
the retailer/generator to the waste tire collection facility, landfill
of resale as used tires, list the number of used tires removed. These
or processing facility and ensures that retailer/generator has
tires are not those listed in Part 1 above. Provide the storage address
documented proof that their waste tires go to the designated facility.
for the used tires. Please note that sorting of waste tires at a location
other than the retailer/generator requires a waste tire collection permit
INSTRUCTIONS:
from DHEC.
Part 1: Certification by Retailer/Generator – The retailer/generator
Part 3: Certification by Waste Tire Collection Facility, Landfill
of waste tires shall complete all items on this part of the form. Please
or Processing Facility – The waste tire collection facility, landfill or
type or print.
processing facility shall complete Part 3 of the form.
List the name of the retailer/generator of the waste tires. This
After the form is completed the waste tire hauler will provide the
may either be the name of the business or, if it is not a business,
completed and signed manifest to the retailer/generator of the waste
the name of the person generating the waste tires.
tires within 30 days and retain a copy of the completed and signed
Provide the name of the owner of the business.
manifest for their records per Regulation 61-107.3.
List the business address or, if it is not a business, the home
Office Mechanics and Filing – DHEC’s Division of Compliance and
address of the person generating the waste tires.
Enforcement will file and retain manifests that it requests from waste
List the business telephone number or, if it is not a business,
tire haulers for matters of compliance and enforcement. File retention
is three years from the termination date of the registration.
the home telephone of the person generating the waste tires.
SOUTH CAROLINA DEPARTMENT OF HEALTH AND ENVIRONMENTAL CONTROL
Page 2 of 2
DHEC 2738 (8/2014)
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