6. Businesses Where Tires will be Transported and Deposited (attach additional sheets as needed) Name Address Telephone Disposition Retread Recycling Recap 1. Resale Processing Disposal Retread Recycling Recap 2. Resale Processing Disposal Retread Recycling 3. Resale Processing Disposal Retread Recycling 4. Resale Processing Disposal Retread Recycling Recap 5. Resale Processing Disposal Retread Recycling Recap 6. Resale Processing Disposal Retread Recycling 7. Resale Processing Disposal Retread Recycling Recap 8. Resale Processing Disposal 7. Certification To the best of my knowledge, I certify the information provided is true and correct. Signature of Authorized Agent Print/Type Authorized Agent Name and Tile Date
6. Businesses Where Tires will be Transported and Deposited (attach additional sheets as needed) Name Address Telephone Disposition 1. Retread Resale Recycling Processing Recap Disposal 2. Retread Resale Recycling Processing Recap Disposal 3. Retread Resale Recycling Processing Disposal 4. Retread Resale Recycling Processing Disposal 5. Retread Resale Recycling Processing Recap Disposal 6. Retread Resale Recycling Processing Recap Disposal 7. Retread Resale Recycling Processing Disposal 8. Retread Resale Recycling Processing Recap Disposal 7. Certification To the best of my knowledge, I certify the information provided is true and correct. Signature of Authorized Agent Print/Type Authorized Agent Name and Tile Date
2--used-tire-transporter-license.docx