WT-1M Mobile Waste Tire Processor 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 mobile waste tire processor location)

Registrant information

Certificate of registration ID# *

Business name *

DBA

Mailing street address

Mailing city

Mailing state

Mailing zip

Is your business still a mobile waste tire processor? If you select "No", you will no longer be considered a mobile waste tire processor and your information will be removed from our database. *

Yes

If you are no longer a mobile tire processor, do not continue with updating your contact information. Please sign, date and submit the form.

As a mobile waste tire processor, you must have:
• Financial assurance already maintained as part of registration as a waste tire processor, waste tire collection facility or a waste tire monofill.

• Financial assurance in the amount of $10,000.00 specifically as a mobile waste tire processor.

Do you have the required financial assurance as stated above? *

Yes

Principal contact *

Contact phone *

Contact email

Confirm contact email

Business phone *

Business email

Confirm business email

Sign and certify

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 *