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WT-1H Waste Tire Hauler Application Renewal

Has your physical address changed since you last renewed? *

Yes

If you need to change your location address, please email cdphe.hmwastetires@state.co.us. (Subject line: Register New Tire Hauler Location)

Certificate of registration ID# *

Business name *

DBA

Mailing street address

Mailing city

Mailing state

Mailing zip

Is your business still hauling waste tires? If you select "No", you will no longer be considered a registered hauler and your information will be removed from our database. *

Yes

If you no longer haul waste tires, do not continue with updating your contact information. Please sign, date and submit the form.

Contact information

Principal contact *

Contact phone *

Contact email

Confirm contact email

Business phone *

Business email

Confirm business email

Vehicle information

How many vehicles in your fleet will be used to haul waste tires? *

Do you haul waste tires for other businesses and customers? (Choose "No" if you only haul waste tires for your business, and you do not haul/pick up waste tires from other businesses or customers.) *

Yes

Please select the regions in which you provide service (Select all that apply):

Metro

Pikes Peak

Northeast

Southeast

Southwest

West Central

Northwest

Optional: contracted commercial/freight carrier decals

Enter the number of contracted vehicles not in your fleet that will be used to haul waste tires. (There are six decals to a sheet. Enter the number of decals you need, not the number of sheets.)

For the purposes of this form, the Colorado Department of Public Health and Environment accepts your typed name, title 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.

Authorized representative's signature *

Title *

Date * +

By checking this box I certify the information on this application renewal form is, to the best of my knowledge, true, accurate and complete in all respects.

Please enter an email address to recieve a PDF receipt of your submission.

Notification email *