___________________________________________________ MARICOPA COUNTY 2014 WASTE TIRE GENERATOR DISPOSAL PERMIT

Form can be saved and emailed to McCartneyr@mail.maricopa.gov
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