Scrap Tire Hauler Registration Application

Scrap Tire Hauler Status:*field type radio button
Scrap Tire Hauler Status:NewRenewalUpdate Info
Scrap Tire Hauler ID Numberfield type single line
NCT-##### - For Renewal or Update Info applications only
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Business name of hauler:*field type single line
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Phone:*field type single line
###-###-####
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Owner of hauler service:*field type single line
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Contact person:field type single line
if different from owner
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Mailing address of hauler:*field type single line
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City:*field type single line
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County (North Carolina):field type drop-down
If out of state, select Out of State
Out of State County (Other):field type single line
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State:*field type single line
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Zip-code:*field type single line
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Hauler's e-mail address:*field type email
Counties in NC to be served:*field type multi line
Does the Scrap Tire Hauler also collect Scrap Tires in another State?*field type checkbox
Does the Scrap Tire Hauler also collect Scrap Tires in another State?YesNo
If yes, in which State(s)?field type multi line
Only Scrap Tires collected in the normal course of business in North Carolina qualify for free disposal.
Number of vehicles to be used:*field type single line
Input blocked. Maximum character limit of 4000 characters reached.

List all solid waste facilities where you will drop scrap tires or processed tires for disposal or recycling

	Facility Name*field type multi line	Facility Address and ZIP code*field type multi line	Facility County*field type drop-down	Facility County (Out of State Only)field type single line
1×	Facility Name*field type multi line	Facility Address and ZIP code*field type multi line	Facility County*field type drop-down	Facility County (Out of State Only)field type single line Input blocked. Maximum character limit of 4000 characters reached.	×

Add

Please submit the following information for each vehicle you will use to transport scrap tires. If you are using more than two vehicles, attach additional sheets to provide the information for each vehicle.

	Make and Model*field type multi line	License plate number of vehicle*field type single line	State that issued License plate*field type drop-down	DMV registration number or VIN#*field type single line
Vehicle 1×	Make and Model*field type multi line	License plate number of vehicle*field type single line Input blocked. Maximum character limit of 4000 characters reached.	State that issued License plate*field type drop-down	DMV registration number or VIN#*field type single line Input blocked. Maximum character limit of 4000 characters reached.	×

Add

Additional vehicle sheet:field type file upload
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Certification

By sending this application into the Scrap Tire Program, I acknowledge that I have read and understand the scrap tire regulations and laws.
Signature:*field type signature
Date:field type date
Date will be captured on form submission

Program Contact Information

Scrap Tire Program
Solid Waste Section
1646 Mail Service Center
Raleigh, NC 27699-1646

Phone: (919) 280-4814.
E-mail: john.patrone@ncdenr.gov

Internet: http://deq.nc.gov/about/divisions/waste-management/scrap-tires