NCT03340_20190326_Application

NC DEPARTMENT OF ENVIRONMENTAL QUALITYDIVISION OF WASTE MANAGEMENT
Scrap Tire Hauler Registration Application
1.Scrap tire hauler status: New )( Update Info ___ Current ID# NCT (will be blank if�-----��¼u� 2.Business name of Hauler: (jaodeL d-- �FF-e.,v/S Phone#: [phone]
3.Owner ofHauler Service: t.e..nA�:t-f\ C..1/c)u._de.l..,RECEIVED 4.Contact Person (if different from owner): ___ A./'_/ ___ '4_� ________ M_A_R _2_G 2019l
5.Mailing address of Hauler: l YO Y C,,h,t( {-c.S c.S:-f SOLID WASTE SECTION
City: {w-/,e_,,j;h County: Wrt"fC.e-State: fl.(. Zip: 2. 7p /l) 6.Hauler's Email Address � \l,w � (1-o� er .50 &J 3 mnr t ,�7.Counties to be served: Wake, Cumberland, Johnston, New Hanover, Guilford, Mecklenburg,
Durham, Nash, Vance, and Pitt.
8. List all facilities where you will take scrap tires or processed tires for disposal or recycling(attach additional sheets if necessary)
Facility
North Wake Multi-Material Recycling Facility
Address . County
9 v i CJ !J.L po n i'e /}//. w 4:IL e
Raleigh 27614
9.Number of vehicles to be used: /-----
10. Please submit the following information for each vehicle you will use to transport scrap tires. Ifyou are using more than one vehicle, attach additional sheets to provide the information for each vehicle.
a.Description of vehicle: 1mD V,tvb.License plate number of vehicle: 'P J H -7 Le 8 3c.D,Partment of Motor Vehicles registration number or VIN#: 1�E&Si5 09'2-lbiito yff€h -j-d.Name ofregistered vehicle owner: C.,h&nr1 ;;} � cyt1:11L · .
By sending this application in to the Scrap Tire Program I acknowledge that I have read and understand the scrap tire regulations and laws 4.lS Q or No) If you have print capabilities AND an email address-may we email the �ti�ertificate to you??
Return completed form to: Scrap Tire Program, Solid Waste Section, 1646 Mail Service Center, Raleigh, NC 27699-1646
Fax: [phone] Email: [e-mail].
Phone: [phone] FAX: [phone] Internet: http://portal.ncdenr.org/web/1MTI/sw/scraptires
White 2002 Chrysler Voyager
NCT03340
issued: 3/26/19