Commercial Waste Tire Annual Report Form (WT-4) Calendar Year 2023

Hazardous Materials and Waste Management Division

Solid Waste and Materials Management Program

Annual Waste Tire Hauling Activity Report for the period of

January 1, 2023 - December 31, 2023

Hauler information

Waste tire hauler name *

Check box if this form covers annual report information for multiple Waste Tire Hauler registrations.

Certificate of Registration number(s) *

Street address *

City or town *

State *

Zip *

Is your mailing address the same as your physical address? *

Yes

No

Mailing address *

City or town *

State *

Zip *

Hauler contact name *

Telephone *

Fax number

Email address *

This reporting form must be submitted by March 1 of each year for the previous calendar year's waste tire hauling activities.

If you have any questions regarding this form, please contact Shana Baker at 303-692-3305 (1-888-569-1831 ext. 3305 toll-free) or send an email to cdphe.hmwastetires@state.co.us.

Reporting

Under 6 CCR 1007-2 Section 10 of the Colorado Regulations Pertaining to Solid Waste Sites and Facilities, waste tire haulers must report annually to the department on or before March 1st of each year, reporting on their waste tire hauling activities of the previous calendar year.