Department of Public Safety Tire Hauling

First Name

Last Name

Email Address

Phone Number

Address

Doing Business as name

Business type
- select - Sole Proprietor Partnership Partnership Limited Partnership Limited Liability Partnership Limited Liability Corporation Corporation Trust

Do you have City of St. Louis Business License?

Charter Number

Date Organized

State of organization/incorporation

Are You in good standings with the state in which you are organized?

Provide a list of company officers/partners

MDNR Permit Number

USDOT Number

Street Address

City

State

Zip Code

City
Do you move tires within the limits of the city of Saint Louis?

Interstate
Do you travel through, but not stop in, the City of Saint Louis when transporting waste tires?

Number of waste tires transported each month

Weight of waste tires transported each month

Is your business currently in violation of City Ordinance 71123 or Sections 260.270-260.278 RSMO?
Answering YES will not result in an automatic denial. If you answer NO and it is determined that you have been in violation, your application WILL be denied.

If yes, list details of Violation number, county, case number date, charge(s) and disposition of case

"I confirm I will upload the form that lists company drivers with their license information and also list all receiving facilities."

First Name

Last Name

Email Address

Phone Number

Address

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Vehicle listing
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Building compliance statement
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Fire compliance statement
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Applicant, confirm legal name

Applicant title

Applicant, confirm email address

I consent, on behalf of the company and its affiliates to investigation by the City of St. Louis and its agents
I consent, on behalf of the company and its affiliates to investigate by the City of St. Louis and its agents

Under Penalty of perjury under the laws of the stat of Missouri and the Unites States of America, the information in this application or attached hereto is true, correct and complete
Under penalty of perjury under the laws of the state of Missouri and the United States of America, the information in this application or attached hereto is true, correct and complete to the best of my knowledge.

I understand that commercial motor vehicle safety regulations apply to motor carries operating in the transportation of waste tires.
For more information about safety regulations that apply to your operation visit the Safety & Compliance section of www.modot.org/mcs.