Colorado Department of Public Health and Environment
Hazardous Materials and Waste Management Division
Solid Waste and Materials Management Program
Monthly New Tire Self Certification Form (WT-9)
 
New Motor Vehicle or New Trailer Tires Sold at Multiple Locations
 
RETAILER OF NEW WASTE TIRES INFORMATION  
Contact Person
 
This reporting form must be submitted the 20th of each month, reporting on new motor vehicle or trailer tires sold the previous month.
 
If you have any questions regarding this form, 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.
 
Reporting
Under 6 CCR 1007-2 Section 10 of the Colorado Regulations Pertaining to Solid Waste Sites and Facilities, any person who aggregates monthly tire fees from multiple stores must report monthly to the department the number of new motor vehicle or new trailer tires sold at each location.
 

Check here if this is an amended return.
Check here if you no longer sell new tires.
Check here if no tires sold this period.
Amount Owed (Total Tires Sold X $1.50 per tire)
$0.00
NOTE: The fee will drop to $0.55 starting January 1, 2018.

I certify that:

1. I have personally examined and am familiar 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.
 
(Signature required for mail in payments.)
calendar
 
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.