Processed Recycled Asphalt Shingles Certification Form (Form 820010b)

 

RECYCLED Asphalt Shingle SUPPLIER (1)

Company Name

 

Address

 

Phone

 

Contact Name

 

RAS Stockpile ID

 

(1) Required for non-End Users

 

End User

Company Name

 

Address

 

Phone

 

Contact Name

 

RAS Stockpile ID(2)

 

(2) Required if Supplier is also the End User

 

□  Pre-consumer

□  Post-consumer

(Check One)

We undersigned certify the following:

 

1.                  tons of asphalt shingles have been processed, sized (100% by weight passing the -inch sieve, 98% by weight passing the 3/8-inch sieve, and 90% by weight passing the #4 sieve), and delivered. (Report number of tons)

 

2.     All visible materials not part of the shingle, including but not limited to wood, paper, metals, glass, rubber, soil, brick, tars, and plastics were removed prior to processing.

 

3.     The material does not contain more than 1.5% deleterious material by weight.

Note: Deleterious material consists of paper, plastics, wood, metal, glass, rubber, soil, brick, tars, and any other material not part of the asphalt shingles.

 

4.     The moisture content (%) of the load is _____________.

 

5.     The material meets all requirements of Materials IM 506.

 

 


Asphalt Shingle Supplier (signature)                                                  Date

 

 


End User (signature)                                                                          Date