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To be completed by generator.
(County and State)
(Provide copies of E500G or E500
tax reports or other documentation
if required by county.)
(Provide proof of eligibility for free disposal if required by county.)
(Provide proof tires were purchased in NC and proof of payment of disposal tax if required by county.)
(e.g.Cleanup projects, pre-1994, stockpiles from businesses and junkyards)
Must have original signature.
To be completed by hauler.
(Applies only to retailers hauling their own tires)
To be completed by collector.
This field is not part of the form submission.
* indicates a required field