New Waste Tire Fee Return Form WT-6

The fees collected each month are due to the department no later than the 20th day of the following month.
 
This is the form for reporting for a single store. If you need to report for multiple stores, please contact Lisa Jeffrey at 303-692-3437  (1-888-569-1831 ext. 3437 toll-free) or send an email to cdphe_wastetirefees@state.co.us.
In order to report your waste tire volumes, please go to the New waste tire fee webpage for further instructions.
This is the form for reporting for a single store.
If you need to report for multiple stores, please contact
Lisa Jeffrey at 303-692-3437 (1-888-569-1831 ext. 3437 toll-free)
or send an email to cdphe_wastetirefees@state.co.us.
Is this is an amended return? *
Check here if you no longer sell new tires
Check here if No Tires Sold this period
Line 2 - Amount Owed
$0.00
Hit Calculate button and record this value for use on the payment page.
Method of payment: *
________________________________________________________________________________________________________

I certify that:
 
1. I have personally examined and am familair with the information contained in this submittal;
2. The information contained in this submittal is, to the best of my knowledge, true, accurate and complete in all respects; and
3. I am fully authorized to make this certification on behalf of this facility.
 
I am aware that there are significant penalties including, but not limited to, possible fines and imprisonment for willfully submitting false, inaccurate or incomplete information.
 
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For the purposes of this form, the Colorado Department of Public Health and Environment accepts your typed name and date as an electronic signature equivalent to your valid signature on a paper copy of the form. As such, this electronically completed form bears the same rights and responsibilities as a hand-signed form.
 
Once your form has been submitted successfully, you will be re-directed to the Waste Tire pay portal.
 
A copy of the completed form will be sent as an attachment to the contact person at the email address provided. Please retain a copy in your facility files.