Waste Tire Collection Even Request

Requester and location information

This form is intended for use only by state and local governmental agency employees.

State/local organization name *

Contact name *

Job title *

Street *

City *

State *

Zip *

Contact email *

Contact phone *

Location of the collection event

Site name *

Street *

City *

State

Zip *

County *

Type of property *

Private

Commercial

Public

1. What is the estimated number of waste tires to be collected? *

2. What types of waste tires will be collected (passenger, semi-trailer, truck, agriculture, ATV, etc.)? *

3. What is the estimated date and time for the collection event? *

4. Who will be allowed to drop off tires at the event (residents, non-residents, government employees only, etc.)? *

5. If residents only, how will you confirm they are residents within your jurisdiction?

6. What is the estimated population within your jurisdiction? *

7. Other than waste tires, will other solid waste be collected? If yes, what? Will any hazardous wastes be allowed for drop off? *

0/150 characters

8. Have waste tire collection events been conducted in the past? If yes, when was the last collection event and how many tires were collected? *

0/150 characters

9. What is the event organizer's experience running a collection event? *

0/300 characters

10. Who will be managing the collection event? Will there be additional staffing? Will they be salaried employees or volunteers? *

0/300 characters

11. Will there be any security during the collection event? If yes, who and what will be their responsibilities during the collection event? *

0/300 characters

12. Is there space at the collection event site to have a trailer onsite to store the waste tires in a secured area with no public access? *

13. How will the collection event be advertised? *

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14. Will any informational flyers or other correspondence be handed out to people who are dropping off waste tires? *

15. Have you received quotes from registered Waste Tire Haulers to remove the waste tires after the event? If yes, please list any Waste Tire Haulers contacted, the proposed destination of the waste tires, and how the waste tires will be end used. *

0/750 characters