Form 4B "Scrap Tire Recovery Facility Refusal Log" - Ohio

What Is Form 4B?

This is a legal form that was released by the Ohio Environmental Protection Agency - a government authority operating within Ohio. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on August 1, 2020;
  • The latest edition provided by the Ohio Environmental Protection Agency;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of Form 4B by clicking the link below or browse more documents and templates provided by the Ohio Environmental Protection Agency.

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Download Form 4B "Scrap Tire Recovery Facility Refusal Log" - Ohio

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Scrap Tire Recovery Facility Refusal Log  
{As required by OAC Rule 3745‐27‐65}  
Division of Materials and Waste Management 
 
 
 
Scrap Tire Recovery Facility – Log of Operations     Scrap Tire Load Refusal/Not Processable Form  
This form shall be completed by the owner/operator of the scrap recovery tire facility when a load of scrap tires is 
refused at the time of delivery or after receipt and upon determination that the scrap tires cannot be processed. The 
scrap tire transporter shall take this form to a licensed solid waste facility. The scrap tire recovery facility and solid 
waste facility shall retain this form with their daily log of operations.  Please note: This form must accompany the 
Ohio EPA three‐part shipping/receiving form or an equivalent form that contains the information required in OAC 
Rule 3745‐27‐57(D) to the solid waste facility. 
A.  Scrap Tire Recovery Facility Information 
Facility Name: 
 
Facility Address: 
 
Contact Name: 
 
Phone:   
B. Refused/Removal of Load of Not Processable Scrap Tires 
Date Load Refused: 
 
‐OR‐    Date Not Processable Load Prepared for Removal: 
 
Amount of scrap tires refused/rejected: 
 
[mark applicable unit]  
  tons    
  number   
  cubic feet 
Ohio EPA Scrap Tire Transporter Registration Number or Business Name: 
 
License Plate #: 
 
Reason for Refusal/Removal at Scrap Tire Recovery Facility [OAC Rule 3745‐27‐15(E)(8)(iv)] 
 
Scrap tire construction (prevents equipment from processing scrap tires)  
 
Scrap tires are contaminated (with mud or other materials that render the tires unsuitable for processing) 
 
Other Reason for Refusal/Removal (specify below) 
 
C. Receiving Facility Information 
Solid Waste Facility Name: 
 
Date Load Received: 
 
Facility Address: 
 
Contact Name: 
 
Phone: 
 
Amount of scrap tires received:   
[mark applicable unit]  
  tons    
  number   
  cubic feet 
 
 
OAC Rule 3745‐27‐65 
Scrap Tire Log – Form 4b 
8/2020 
 
Scrap Tire Recovery Facility Refusal Log  
{As required by OAC Rule 3745‐27‐65}  
Division of Materials and Waste Management 
 
 
 
Scrap Tire Recovery Facility – Log of Operations     Scrap Tire Load Refusal/Not Processable Form  
This form shall be completed by the owner/operator of the scrap recovery tire facility when a load of scrap tires is 
refused at the time of delivery or after receipt and upon determination that the scrap tires cannot be processed. The 
scrap tire transporter shall take this form to a licensed solid waste facility. The scrap tire recovery facility and solid 
waste facility shall retain this form with their daily log of operations.  Please note: This form must accompany the 
Ohio EPA three‐part shipping/receiving form or an equivalent form that contains the information required in OAC 
Rule 3745‐27‐57(D) to the solid waste facility. 
A.  Scrap Tire Recovery Facility Information 
Facility Name: 
 
Facility Address: 
 
Contact Name: 
 
Phone:   
B. Refused/Removal of Load of Not Processable Scrap Tires 
Date Load Refused: 
 
‐OR‐    Date Not Processable Load Prepared for Removal: 
 
Amount of scrap tires refused/rejected: 
 
[mark applicable unit]  
  tons    
  number   
  cubic feet 
Ohio EPA Scrap Tire Transporter Registration Number or Business Name: 
 
License Plate #: 
 
Reason for Refusal/Removal at Scrap Tire Recovery Facility [OAC Rule 3745‐27‐15(E)(8)(iv)] 
 
Scrap tire construction (prevents equipment from processing scrap tires)  
 
Scrap tires are contaminated (with mud or other materials that render the tires unsuitable for processing) 
 
Other Reason for Refusal/Removal (specify below) 
 
C. Receiving Facility Information 
Solid Waste Facility Name: 
 
Date Load Received: 
 
Facility Address: 
 
Contact Name: 
 
Phone: 
 
Amount of scrap tires received:   
[mark applicable unit]  
  tons    
  number   
  cubic feet 
 
 
OAC Rule 3745‐27‐65 
Scrap Tire Log – Form 4b 
8/2020