Form can be saved and emailed to [email protected] PERMIT # 14- MARICOPA COUNTY 2014 WASTE TIRE GENERATOR DISPOSAL PERMIT ___________________________________________________ Name of company: __________________________________________________________________________________ Type of business: _______ New tire sales* _____ Used tire sales _______ Other (explain) ________________________________________________________ ______One time special clean-up Sales tax ID# ______________________________________________________________________________________ *A copy of a current Business License must be provided by all Regular permit holders / Tire Dealers Street address: ______________________________________________________________________________________ City:_______________________________ State: _________________ Zip Code: _________________________ State: _________________ Zip Code: _________________________ Mailing address (if different): City:_______________________________ Telephone: ____________________________________________________ ___________________________________________________ Pursuant to Article 8 Waste Tire Disposal, A.R.S. 44 -1302, F, Maricopa County is required to establish a registration procedure for their waste tire collection sites. In accordance with this statute, any business or person who generates waste tires in Maricopa County and desires to dispose of these waste tires in a Maricopa Waste Tire Collection Site, must register and have a current Waste Tire Disposal Permit. I, ______________________________________, as an authorized representative of the above noted waste tire generator, hereby agree to comply with all applicable Arizona Waste Tire Disposal laws, regulations and ordinances. Enter eMail Address below ______________________________________________________________________________________ Authorized Representative Signature Date Waste tire generator has been issued: ____ Regular Permit ____ ____ Special Permit ____ Expiration Date: 12-31-14 Expiration Date:____________ __ Send to Applicant ______________________________________________________________________________________ Waste Resources & Recycling Representative R Date Maricopa County Waste Resources & Recycling P P4 480-987-2498