Email: PermitSection@miamidade.gov …

1 - 1 - Department of Solid waste Management Permit Section 2525 NW 62nd Street, 5th Floor miami , FL 33147 Phone: 305-514-6610 Fax: 305-514-6880 Email.

2 APPLICATION FOR PERMIT TO GENERATE AND/OR TRANSPORT waste TIRES SECTION 1 ALL APPLICANTS _____ CORPORATE NAME _____ DOING BUSINESS AS (DBA) _____ ADDRESS WHERE BUSINESS IS LOCATED _____ CITY, STATE ZIP _____ NAME OF OWNER/PRESIDENT/ LOCAL MANAGING PARTNER _____ TITLE OF ABOVE _____ PREFERRED MAILING ADDRESS _____ CITY, STATE ZIP _____ CONTACT PERSON FOR PERMIT INFORMATION _____ PHONE # _____ E- MAIL ADDRESS 1ST TIME APPLICANT RENEWAL FOR 1ST TIME APPLICANTS.

3 IF THIS BUSINESS WAS PREVIOUSLY PERMITTED UNDER A DIFFERENT BUSINESS/NAME, PLEASE PROVIDE THE FOLLOWING: NAME ON PERMIT: _____ _____ PREVIOUS PERMIT ACCOUNT # _____ _____ (THE PERMIT ACCOUNT # IS NOT THE DECAL/STICKER NUMBER) Please use the following definitions to identify whether your business is a Tire Generator, waste Tire Hauler or Both. A waste Tire Generator is defined as any person that is either principally or partially engaged in the selling, trading or otherwise transferring of new, used or waste tires, whether such transactions are for cash, barter or without consideration.

4 Retail and wholesale tire stores and other businesses that remove used or waste tires from vehicles fall within this category. A waste Tire Transporter is defined as any person transporting five or more waste tires . Based on the definitions above check ( ) one of the following: waste Tire Transporter Complete S ections 1, 2, 4 & 5 waste Tire Generator Complete Sections 1, 3, 4 & 5 Both Complete all Sections of the Application It is unlawful for any person to carry on or conduct business or profession in miami - dade County without first obtaining a Local Business Tax Receipt (LBTR) from the county in which the business resides.

5 Please provide your Local Business Tax Receipt information below: County of Issue _____ Receipt # _____ Expiration Date :_____ If the county of issue is outside of the State of Florida, a miami - dade County LBTR is required. For information on the miami - dade County Local Business Tax Receipt, please contact the Office of the Tax Collector, 200 NW2nd Avenue, 3rd Floor, miami , FL 33128. Phone: 305-270-4949. - 2 - SECTION 2 FOR waste TIRE HAULERS VEHICLE LIST For each vehicle transporting waste tires in miami - dade County complete the following and submit a copy of the current vehicle registration and proof of insurance for each truck and/or trailer.

6 Attach additional sheets if needed. YEAR MAKE/MODEL TAG# Vehicle ID (VIN) # LIST THE COMPLETE NAME AND ADDRESS AND PHONE NUMBER FOR EVERY LOCATION THAT YOU HAVE REMOVED waste TIRES FROM WITHIN THE PAST 12 MONTHS. Attach additional sheets if needed. NAME ADDRESS CITY, STATE and ZIP PHONE # LIST THE NAME AND COMPLETE ADDRESS OF EVERY LOCATION OR FACILITY YOU HAVE USED TO DISPOSE OF waste TIRES WITHIN THE PAST 12 MONTHS. Attach additional sheets if needed. NAME ADDRESS CITY, STATE, ZIP ** PROVIDE THE TOTAL AMOUNT( IN NUMBER OR TONNAGE) OF waste TIRES COLLECTED FROM THE TIRE GENERATORS LISTED IN SECTION WITHIN THE PAST 12 MIONTHS: _____ - 3 - SECTION 3 FOR waste TIRE GENERATORS LIST OF TIRE GENERATOR SITES Please list the names and complete addresses of each tire generator location that will be operating under this permit account.

7 Attach additional sheets if needed. NAME ADDRESS CITY, STATE, ZIP PHONE # LIST ALL waste TIRE HAULERS USED TO REMOVE waste TIRES FROM THE LOCATIONS LISTED IN WITHIN THE PAST 12 MONTHS. All waste tire haulers used must have a current p ermit with this Department. To avoid violation, please verify the hauler s permit account status before employing them to remove your waste tires. SOLID waste DEPT. TIRE HAULER PERMIT # NAME ADDRESS PHONE # ** PROVIDE THE TOTAL AMOUNT OF waste TIRES IN NUMBER OR TONNAGE REMOVED FROM ALL OF YOUR LOCATIONS WITHIN THE PAST 12 MONTHS: _____ SECTION 4 ALL APPLICANTS Provide a check, cashier s check or money order in the amount of the total fees due payable to the Department of Solid waste Management.

8 Most credit/debit cards are also accepted. Payment is also accept by phone. All checks are processed using Electronic Check Service (ECS). If you choose not to have your check converted electronically. You must notify us in writing or in person prior to or along with the remittance of the check for payment. If payment is unable to be converted, it may be processed as a Check Replacement Document drawn against your account. If payment is returned due to insufficient funds, you authorize us to make a one-time electronic fund charge of $25 or 5% (whichever is greater) from your account to collect a fee as allowed by state law.

9 Permit Application/Renewal Fee = $ _ + Tire Haulers: Vehicle Registration Fee $25 x _____ vehicles = $ _____+ Tire Generators: $75 x _____ locations = $ _____ = Total Amount Due $ _____ - 4 - SECTION 5 ALL APPLICANTS AFFIDAVIT As an owner, officer, or local manager of the business entity submitting this application for permit to generate tires and/or transport waste tires in miami - dade County, it is understood that: A It shall be unlawful for any person to remove, collect, or transport within miami - dade County five or more waste tires without first obtaining a waste tire permit from the Department of Solid waste Management.

10 B. It shall be unlawful for any business to employ or hire a waste tire hauler who fails to obtain a permit from the Department of Solid waste Management and/or who fails to display a current vehicle decal as required under Chapter 15 of the miami - dade County Code (Code). C. It shall be unlawful for any person to sell, trade or otherwise transfer used or waste tires within miami - dade County without first obtaining a Tire Generator permit from the Department of Solid waste Management as required by the Code.