Larimer County Tire Disposal Manifest

If you are hauling 10 or more tires to the landfill, you are required to fill out the tire manifest displayed below. Please print the manifest, fill it out, and have it ready to give to the gate attendant at the landfill. If you have questions regarding this procedure, please call 498-5760 between 8:00 and 4:30, Monday through Friday.

To be completed by Generator

Company Name ____________________________________________________________

Business Address _____________________________________________________________

City ____________________________ State _________ Zip _________________

Address of Shipment Origin___________________________________________________

Authorized Contact _____________________________________________________

Emergency Phone ______________________________________________

Number of Tires ________________________________________________

Other Material ____________________________________________________
I hereby certify that the above wastes were consigned to the Carrier named below and that the above waste originated from residents of Larimer County or from a business whose main place of business is located in Larimer County.

Signature ______________________________________________

Title ____________________________________________ Date _______________

I hereby certify that the above wastes were consigned to me by the Generator named above and that the above waste is in compliance with all waste acceptance policies of Larimer County in effect as of this date. If the above waste does not meet current Larimer County standards, or is not consistent with any statements made on this manifest, I agree to pay any and all clean-up and removal costs associated with the above waste including any fines, attorneys' fees, disposal fees, testing fees, or any other associated costs incurred by Larimer County.

Hauler Signature __________________________________________

Company _______________________________________________

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Received by Larimer County Landfill Date ___________________________

Gate Attendant ________________________________________

GATE ATTENDANT RETAINS MANIFEST LCNR-70 (5/91)