Florida Department of Environmental Protection Waste Tire Collector Registration Notification Expires April 1, 2017

Transcription

1 Florida Department of Environmental Protection Waste Tire Collector Registration Notification Expires April 1, 2017 Wednesday, April 27,2016 The Company listed below has registered with the Department as a Waste Tire Collector in accordance with Chapter , F.A.C., and registration decals have been issued to the vehicles listed below. These decals are valid until April 1, 2017 unless revoked. Decals must be affixed to the assigned vehicle on the driver's side door of that vehicle. Decals are $35.00 each. For further information call "Waste Tires" at WACS ID: Name: CHUCK'S TIRES, INC. DBA: KRISHAM'S NEW AND USED TIRES No Decal # YR MAKE TYPE VIN # TAG # ST Owner # CHEV PK 1GCEC14T4YE L174NG FL INTL TK 1HTSCPEM1PH H305ZU FL

2 Florida Department of Environmental Protection Bob Martinez Center 2600 Blair Stone Road Tallahassee, Florida DEP Form # (18) Waste Tire Collector Form Title Registration ADPIication Effective Date Januarys DEP Application No. -(eompteted-bypep)- F\\ RO~-'\T--'"' -.?-{JitCT\0\ MAR I'l; Waste Tire Collector Registration Application? Pursuant to Rule , Florida Administrative Code, to obtain a waste tire collector registration number and approval transport waste tires, a collector shall submit the following Information on this fomn to the Department. to Type of Collector: ( ) For Hire Collector ( ) Not For Hire ( ) Registered with ICC ( ) Government Entity Part I- Business Information: 1. Business name of collector: C H U C K ' S T I R E S, INC. WACS ID: (assigned by Department) 2. Other business names of collector (DBA's): K R I S H A M ' S N E W A N D U S E D T I R E S 3. Mailing address of collector: 124 B L A K E A V E City C O C O A State F L Zip Street address of collector: 124 B L A K E A V E City C O C O A County B R E V A R D State F L Zip Telephone number of collector: address: 6. Federal Employer Identification number (FEID) of Collector: Have any enforcement actions been taken by the Department or other governmental agency against the applicant for violation of Department rules relating to the collection or disposal ofwaste tires? This Includes any Complaint, Notice of Violation, revocation or suspension of a registration, as well as any Consent Order In which a violation of Department rules Is admitted. It does not include a Warning Letter, Waming Notiqa Notice of Noncompliance, or other similar document which does not constitute agency action. Yes No If yes, attach a history and description of the enforcement actions. Part II- Person In charge of Waste Tire Collection Operations: 1. Name of Person in charge of Waste Tire Collection Operations: CHARLIE HAM JR 2. Date of Birth of Person in charge of Waste Tire Collection Operations: 10/10/1960 Corporations also complete Part III. 4. Florida Resident Agent of Corporation: Co^f7./i\}/^ > ^ M ^ 1. Corporation Name: C H U C K ' S T I R E S, INC. 2. Corporation Filing Date: / ^ / State of Incorporation: 7^J - 0I 0 /}- 3. Corporation Officers: T L l j ^ i - l T C L,» W M " S H, T I F O / / ^ > K ^ 3-2/- Page 1 of 2

3 Part IV> Collection and Disposal Information: 1. List all known locations where you will be collecting waste tires (attach additional sheets if necessary) j n 5te^ DEP Form # (18) Waste Tire Collector Form Title Registration Application Effective Date Januarys DEP Application No. (Completed by DEP) W A C S ID: INcjriltJ Name Address City State /Pfrr/^FM/h 2. List all known locations where you will be delivering or depositing waste tires for recycling or disposal (attach additional sheets if necessary): p g > e X ^ ^ ^ ^ & ' ^ ' ^ F ^ ^ivt> /fo^j^%^ Part v.- Vehicles to be Registered: 1. Number of vehicles to be used: A 2. Vehicles registration Information: a. A legible copy of the current vehicle registration is required for each vehicle registered. The registration must show State of registration, year, make, tag number, vehicle Identification number, and registered owner. b. IE the vehicle is not owned by the collector, an authorization from the vehicle owner for the vehicle to be registered for waste tire collection must be attached to this application. c. IF Common Carrier, list Interstate Commerce Commission ICC authority number for the company: Part VI. Registration Fee Information y^y^ 1. Waste tire collector registration status: New Renewal If registration is a renewal, list previous registration llstration numberfs) number(s_) ^ 2. Attach payment for registration fees pursuant to Rule (11), F.A.C. Number of vehicles # x$35= $ 7 ^ = Amount of Payment Part VII.- Certification To the best of my knowledge and belief, I certify the Infonnatign provided In this application Is true, accurate, and correct. I have attached all documents and/or authorizations that are required. CHARLIE HAM JR _ AA^4^PC3t>^.vi.. ^~%-/L Print Name of Authorized Agent Signature of Authorized Aoent Date Mall completed fonn to: Florida Department of Environmental Protection Division of Waste Management / Tires 2600 Blair Stone Road, MS 4550 Tallahassee, Florida Page 2 of 2

4 Collecting Waste Tires: 2000 Auto 7200 Dolina Ct. Melbourne, Fl Chuck's Tires Inc dba Krishams Bob Steele Chevy 124 Blake Av 2800 W. King St Cocoa, Fl Cocoa, Fl fhmill-"liliiliillitini 485 Cove Rd Merritt Island, Fl

5 ATTACHMENT TO WASTE TIRE COLLECTOR RENEWAL FOR /21/2016 Your c u r r e n t Waste T i r e C o l l e c t o r Decals a r e a s s i g n e d t o t h e v e h i c l e s shovm below. These d e c a l s w i l l e x p i r e on A p r i l 1, I T I S YOUR RESPONSIBILITY TO V E R I F Y THE VEHICLE INFORMATION. P l e a s e make a d d i t i o n s o r d e l e t i o n s a s needed f o r t h e upcoming y e a r. YOU MUST SEND CURRENT v e h i c l e r e g i s t r a t i o n s f o r each v e h i c l e you w i s h t o r e g i s t e r f o r t h e y e a r ending A p r i l 1, We w i l l a s s i g n new d e c a l s b a s e d on t h i s i n f o r m a t i o n. P l e a s e r e t u r n t h i s attachment w i t h your a p p l i c a t i o n. WACS ID: BUSINESS NAME: CHUCK'S TIR^S, INC. YEAR MAKE TYPE TAG STATE VIN OWNER NO CHEV PK L174NG FL 1GCEC14T4YE INTL TK H305ZU FL 1HTSCPEM1PH Page 1 of 1

6 CO/AGY 19 n T# B# FLORIDA VEHICLE REGISTRATION ; PLATE H305ZU DECAL Expires Midnight Sat 12/31/2016 YRAOC 1993/INTL BODY T K COLOR WHI Reg. Tax Class Code 41 VIN 1HTSCPEM1PH TITLE Init. Reg. Tax Months 12 Plate Type R G R N E T W T G V W County Fee 3.00 Back Tax Mos 0 Mail Fee 0.75 Credit Class DUFEID - Sales Tax Credit Months 0' Date Issued 11/3A2015 Plate Issued 12/20/2007 Voluntary Fees, Grand Total KRISHAM'S INC 124 B L A K E AVENUE COCOA. F L IMPORTANT INFORMATION 1. The Florida license plate must remain with the registrant upon sale of vehicle. 2. The registration must be delivered to a Tax Collector or Tag Agent for transfer to a replacement vehicle. 3. Your registration must be updated to your new address within 20 days of moving. 4. Registration renewals are the responsibility of the registrant and shall occur during the 30-day period prior to the expiration date shown on this registration. Renewal notices are provided as a courtesy and are not required for renewal purposes. 5. I understand that my driver license and registrations will be suspended immediately if the insurer denies the insurance information submitted for this registration. RGR - FLORIDA REGULAR FLORIDA VEHICLE REGISTRATION CO/AGY 19 /7 PLATE L174NG DEC/VL Expires / Midnight Thu 6/30/2016 YR/MK 2000/CHEV BODY P K VIN 1GCEC14T4YE Plate Type RGR NETWT 4165 DL/FEID Date Issued 5/4/2015 Plate Issued 6/19/2009 COLOR TITLE 2NDDL# UNK H Reg. Tax Init. Reg. County Fee Mail Fee Sales Tax Voluntary Fees Grand Total T# B« Class Code 31 Tax Months Bat^ Tax Mos Credit Class Credit Months KRIS HAM NEW AND USED TIRES, CHARUE L E E HAM 124 B L A K E AVENUE COCOA, F L R G R - FLORIDA R E G U L A R IMPORTANT INFORMATION 1. The Florida license plate must remain with fter^istranti^xm sale of vdiicte. 2. The legisualion must be delivered to a Tax Collector or Tag Agent for transfer to a replacement vdiide. 3. Your registration tnust be updated to your new address within 20 days of moving. 4. Registrationrencwalsarettieresponsibility of ttie r^istrant and shall occur dming the 30-day period prior to the expiration date shown on this registration. notices are provided as a courtesy and are not required for renewal putposes. 5. I uniterstand that my driver license and registrations will be suspended inmiediately ifthe insurer denies the insurance information submitted for this registration. Renewal _ J

7 Florida Department of Environmental Protection Bob Martinez Center 2600 Blair Stone Road Tallahassee, Florida DEP Form # (22), F.A.C. Form Title:Waste Tire Collector Annual Report Effective Date: January 6, 2010 DEP Application No._ (Completed by DEP) W A S T E TIRE COLLECTOR ANNUAL (FOR YEAR ENDING DECEMBER ) R E P O R T Pursuant to Rule , Florida Administrative Code, waste tire collectors are required to submit the following infonnation to the Department by March 1 of each year. The annual report must be submitted along with the annual registration renewal application and registration fee as a condition of holding a waste tire collector registration number. 1. Business name: C H U C K ' S T I R E S, INC. 2. Business mailing address: 124 B L A K E A V E City: COCOA WACS ID Number: [assigned by Department) State: FL Zip: Business street address: 124 B L A K E A V E City: C O C O A State: F L Zip: Business telephone: address: 5. Total quantity ofwaste tires, expressed in tons, collected or generated during the calend (assumeloo tires per ton or 10 tires per cubic yard): 6. Describe how the waste tires collected were disposed of during the calendar year, reported in tons, (assume 100 passenger tires per ton, 20 truck tires per ton.) A. List total quantity of waste tires sold as used tires. B. List quantity ofwaste tire casings sold A. B. ^5 C. List quantity ofwaste tires hauled off by other Waste Tire Collectors. Attach additional sheets, if necessary Name of Other Collector Collector Registration Number Quantity in D. List the facilities where waste tires were deposited for disposal or recycling and the quantity disposed at each location. Attach additional sheets, if necessary. Name of Facility Address/City/State Quantity in tons TOTAL Tires sold or deposited for disposal or recycling A+B+C+D Page 1 of 2

8 DEP Form # (22) Form Title Waste Tire Collector Annual Report Effective Date January DEP Application No. (Completed by DEP) W A C S ID: Explain any differences between Waste Tires Collected (item 5) and Waste Tires Deposited (item 6): 8. Waste tire collector registration number(s): /^(^^, } H'Cfi ^ 9. Authorized person preparing report: 10. Telephone number of person preparing report: '?? ^ ^ 7 ^ "T^lo ~ ^^^ip? 11. Certification: To the best of my knowledge and belief, I certify the information provided in this report is true, accurate and correct. C H A R L I E H A M J R Print Name of Authorized Agent Signature of Authorized Agent f' Date Mail completed form to: Florida Department of Environmental Protection Division of Waste Management / Tires 2600 Blair Stone Road, MS 4550 Tallahassee, FL Page 2 of 2

9 Home Contact Us E-Filing Services Document Searches Forms Help Detail by Entity Name Florida Profit Corporation CHUCK'S TIRES, INC. Filing Information Document Number FEI/EIN Number Date Filed Effective Date State Status Principal Address Mailing Address Registered Agent Name & Address HAM, CHARLIE L, JR Officer/Director Detail Name & Address Title PST HAM, CHARLIE L, JR Title EVP HAM, CORRINE M P /03/ /03/2014 FL ACTIVE Annual Reports Report Year Filed Date