Florida Department of Environmental Protection Waste Tire Collector Registration Notification Expires April 1, 2016

Transcription

1 ;f FLORIDA \ Florida Department of Environmental Protection Waste Tire Collector Registration Notification Expires April 1, 2016 Friday, May 29,2015 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, 2016 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: TYPIFIED MECHANICAL & SALVAGE DBA: No Decal # YR MAKE TYPE VIN # TAG # ST Owner # DODG TK 1B7HC16Y6WS X11022 AL DODG TK 3B7MC33D7VM X11011 AL GMC BT 1GDJ6H1P0NJ X21044 AL GMC BT 1GDJ6H1P3NJ X11025 AL

2 DEP Form # (18), F.A.C. Florida Department of Environmental Protection Bob Martinez Center 2600 Blair Stone Road TaUahassee, Florida Form Title Waste Tite Collector Registration Application Effective : January 6, 2010 DEP Application No. (Completed by DEP) WASTE TIRE COLLECTOR REGISTRATION APPLICATION e Pursuant to Rule , Florida Administrative Code, to obtain a waste tire collector registration number and approval to transport waste tires, a collector shall submit the following information on this form to the Department. Type of Collector: For Hire Collector 81 Not For Hire Registered with ICC Government Entity Part I- Business Information: 1. Business name of collector: Typified IVIechanical & Salvage ^ACS ID Number 2. Other business names of collector (DBA's): N/A (assigned by Department) 3. Mailing address of collector: POSt Office BOX 613 Kinston City State Alabama Zip street address of collector: 4163 CoUPty Road 5 Kinston City County Geneva state Alabama Zip Telephone number of collector: (334) address: taylorjames50@ymail.com 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 of waste 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, Warning Notice, Notice of Noncompliance, or other similar document which does not constitute agency action. Yes 0 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: J^ITieS TaylOF 2. of Birth of Person in charge of Waste Tire Collection Operations: 02/09/1954 Corporations also complete Part III. 1. Corporation Name: Typified Mechanical & Salvage Holding Trust 2. Corporation Filing. 01/01/2012 state of Incorporation: Nevada 3. Corporation Officers: JameS TaylOf 4. Florida Resident Agent of Corporation: N/A Only Collecting Tires in FloridafromAlabama business location DEP FORM (18) Effective January 6, 2010 Page 1 of 2

3 WACS ID: Part IV- Collection and Disposal Infonnation: 1. List all known locations where you will be collecting waste tires (attach additional sheets if necessary) Name Address City State Unknown, general Tire Dealerstiips & Car dealerships. 2. List all known locations where you will be delivering or depositing waste tires for recycling or disposal (attach additional sheets if necessary): Name Address City State Coffee County Tire Processing Center 415 County Road 279 Elba Alabama Part v.- Vehicles to be Registered: 1. Number of vehicles to be used: 1 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. IF 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. MF Common Carrier, list Interstate Commerce Commission (ICC) authority number for the company: Part VI. Registration Fee Information 1. Waste tire collector registration status: 0 New Renewal If registration is a renewal, list previous registration number(s) 2. Attach payment for registration fees pursuant to Rule (11), F.A.C. Number of vehicles # i x $35 = $ 35 = Amount of Payment Part VII. Certification To the best of my knowledge and belief, I certify the information provi^d ip'this application is true, accurate, and correct. 1 have attached all documents and/or authorizations that are required. James Taylor / AA^Plf / \/ t ^ ^ ' ^ / y ^ 05/29/2015 Print Name of Authorized Agent // Sigriatiflre,x5f^Mth6rized Agent Mail completed form to: Florida Department of Environmental Protection Bureau of Solid & Hazardous Waste / Tires 2600 Blair Stone Road, MS 4550 Tallahassee, Florida DEP FORM (18) Page 2 of 2 Effective January 6, 2010

4 ALABAMA LAW.REQUIRES ORIGINAL OR PHOTOCOPY OF RECEIPT TO BE IN VEHICLE. MVRWaaS3B(1-a0O1) >MLABAMA DEPARTMENT OF REVENUE ISSUING COUNTY COUNTY] CITY CODE TAG YEAR METAL NON USE LAST YEAR DECAL NO. CURRENT YEAR DECAL NO!:^^MOIDB WB«1E REQBTJWTONTAG A»OTAX ISCBPT CODE TAG AFFIDAVIT Geneva Y N DATE ACQUIREtVENTERED STATl ACOUIRED FROM FOR RENEV\fAL NO. OF MONTHS CURRENT YEAR TAG NO. 5/22/2015 AD VAL START DATE VEHICLE IDENTIFICATION NUMBER 1GDJ6H1P3NJ APPL. OR TITLE E ASSESSED VALUE CLASS CODE MAKE STATE GMC 2.99 TRANS. FEE AFF. FEE YEAR HAIWISON DONZDB REDEMPTION FEE PRICEg COUNTY 9.20 ADDl. FEE TAYLOR JAMES 4163 COUNTY ROAD 5 KINSTON, AL TOPKICK BODY PU CITY STT XI LICENSE FEE COLOR TfEL/ SCHOOL 1.38 ISS. FEE 1.25 SCHOOL 01 STATE S/TAX 6 Hospital 1.20 PENALTY STATE TAG NO. FHVUT GROSS WT. NOT OVER COUNTY S/TAX AO VAL CREDIT. CITATION INTEREST TK CURRENT TAG EXPIRES 11/30/2015 CITYSA'AX AD VALOREM PENALTY PD OTHER ST> AD VALOREM INTEREST 34X11025 RENEW THIS TAG IN NOV 2015 AL SALES TAX TOTAL AO VALOREM TAX TOTAL TAGS TAX 100.4:! Sales Rec#: In State - Regular Sale DATE OF ISSUE TIME ISSUED TOTAL PAID 5/29/2015 9:54: Fred Hamic 26 SIGN HERE 1/W1! CFiyrueY / AFFIRM jfl.m Tjif. INFOR.M-VnON CQNTArNI-B IlIiRFiOV IS TRIIH AND COKRKC r.\nr) niavriif vi-nkt/diisalsibrd.abovf LS insitrt n AS KiioiiRnD BY /\I..\BAMA I. AW. OWNERS COPY

5 *E » ALABAMA DEPARTMENT OF REVENUE, MOTOR VEHICLE DIVISION - TITLE SECTION P. O. Box , Montgomery, AL MVT 5-1E (REV 03/10) Application For Certificate Of Title Application # E Application 05/29/2015 jrans Code 3 Legend Codes Current AL Title # Surrendering OOS Title - State Title # Enc AL VEHICLE INFORMATION VIN 1GDJ6H1P3NJ Year 1992 Make GMC Model TOPKICK Body Type CH_ Cyls 8_ Color YEL Purchase 05/22/2015 # Liens _1_ Odo. Reading Reading Type E - Exempt New/Used USED OWNER INFORMATION(FELONY OFFENSE FOR FALSE ADDRESS) Alabama Operator (Lessee) If Different: NarTie TAYLOR JAMES Name Mailing Address 4163 COUNTY ROAD 5 KINSTON, AL Resident Address Gross Selling Price: 300 Trade in Allowance: ^-^^ LIENHOLDER INFORMATION (FELONY OFFENSE FOR FAILURE TO NAME LIENHOLDER WITH INTENT TO DEFRAUD) Alabama law requires that the certificate of title be mailed to the first lienholder. First Lienholder Name '.-;n!,n:i Address DON HARRISON 2109 HWY 84 W Second Lienholder Name Mailing Address OPP, AL of Lien 05/22/2015 of Lien SELLER INFORMATION HARRISON DONZDBA S&H CABINET & Name APPLIANC Physical Address 2109 HWY 84 W OPP, AL SIGNATURES (FELONY OFFENSE FOR FALSE STATEMENTS) I, THE UNDERSIGNED. CERTIFY THAT THE VEHICLE DESCRIBH9 ABOVE IS OWNED BY ME AND I HEREBY MfiKE APPLICATION FOR A CERTIFICATE OF TITLE FOR SAID MOTOR VEHICLE AND THIS VEHICLE WILL NOT BE THE SUBJECT OF UEbi PBIOR TORECEIPT OF TITLE UNLESS INDICATED ABOVE. I FURTHER CERTIFY THAT ALL INFORMATION CONTAINED HEREIN IS TRUE AND CORRECT TO THE BEST OE.MY KNOWLEBG&W<D BE^EF. Owner Signature Owner Signature I HEREBY CERTIFY THAT THE ABOVE DESJ THAT THE V.I.N. AND OESCRI) WITNESSED THE SIGNATURa(S). VEHICLE HAS BEEN PHYSICALLY INSPECTED BY ME AS A DESIGNATED AGENT OF THE DEPARTMENT, AS REQUIRED BY LAW, AND THIS APPLICATION ARE CORRECT. I FURTHER CERTIFY THAT I IDENTIFIED THE PERSON(S) SJ3NING THE APPlflCATION AND DA Signature(s) DA Name GENEVA CTY JUDGE OF PROBATE DA Account Number 34-00/01-00 ATTENTION APPLICANT: You can track the status of your title application by entering the title application number listed above at thefollowingwebsite: titlestatus.mvtrip.alabama.gov A signed copy of this application shall, in accordance with Section , Code of Alabama 1975, serve as a pemiit for the operation of the motor vehide described above until the revenue department issues a certificate of title or refuses to issue a certificate of title and shall continue to serve as evidence of ownership and as a permit for the operation of the vehicle after title is issued. Legends EXEMPT VEHICLE - ODOMETER READING NOT REQUIRED