Deq Form 515 081 PDF Details

Deq form 515 081 is a form used to apply for water discharge permits. The form can be used by individuals or businesses that are looking to discharge pollutants into state waters. The form must be completed and submitted with all required supporting documentation in order to start the application process. Please note that incomplete submissions will not be processed. Form 515 081 is just one of many forms and applications necessary for environmental permitting in the state of Michigan. For more information on how to complete this particular form, please consult the instructions provided below. Instructions can also be found on the Michigan Department of Environmental Quality website at www.michigan.gov/deq . Additional help can also be obtained by contacting DEQ staff directly via email or

QuestionAnswer
Form NameDeq Form 515 081
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesapplicable, InstructionsManifests, INDEMNITY, DEQ

Form Preview Example

OKLAHOMA USED TIRE TRACKING MANIFEST

(SEE INSTRUCTIONS FOR THE USE OF THIS FORM ON THE REVERSE SIDE)

CERTIFICATION: I CERTIFY THAT THE INFORMATION CONTAINED IN THIS DOCUMENT IS TRUE, ACCURATE AND COMPLETE TO THE BEST OF MY KNOWLEDGE.

I. TIRE DEALER/OTHER GENERATOR INFORMATION AND CERTIFICATION

TIRE DEALER/GENERATOR NAME:

TIRE RECYCLING FEE ACCOUNT #:

SALES TAX PERMIT #:

STREET ADDRESS:

 

CITY:

 

COUNTY:

ZIP CODE:

PHONE #:

 

 

 

 

 

 

 

 

 

 

 

# MOTORCYCLE

# ≤ 19.5 INCH RIM DIAMETER TIRES:

 

# >

19.5 INCH RIM DIAMETER

 

# AGRICULTURAL TIRES:

 

TIRES:

 

 

TIRES:

 

 

 

 

CERTIFICATION: I CERTIFY THAT I HAVE REMITTED APPROPRIATE FEES TO THE OKLA. TAX COMMISSION AS A PARTICIPATING TIRE DEALER PURSUANT TO THE PROVISIONS OF THE OKLA. USED TIRE RECYCLING ACT. I FURTHER CERTIFY THAT THE NUMBER OF TIRES RELINQUISHED BY ME, INCLUDING THE NUMBER OF TIRES SHOWN ON THIS DOCUMENT, IS EQUAL TO OR LESS THAN THE NUMBER OF TIRES FOR WHICH I HAVE REMITTED THE TIRE RECYCLING FEE REQUIRED BY 27 O.S. § 2-11-401.2. I UNDERSTAND THAT ANY FALSE STATEMENT MADE HEREIN, KNOWING SUCH STATEMENT TO BE FALSE IS A VIOLATION OF 21 O.S. § 358 AND MAY SUBJECT ME TO FINES AND/OR IMPRISONMENT AS PROVIDED BY 21 O.S. 359.

PRINTED NAME OF RESPONSIBLE INDIVIDUAL:

SIGNATURE:

DATE:

II. HAULER INFORMATION AND CERTIFICATION

HAULER NAME:

 

 

 

TRAILER #:

 

TRUCK LENGTH:

 

 

 

 

 

 

 

 

 

 

 

 

 

STREET ADDRESS:

 

CITY:

 

 

STATE:

 

ZIP CODE:

PHONE #:

 

 

 

 

 

 

 

 

 

 

 

 

# MOTORCYCLE

# ≤ 19.5 INCH

RIM DIAMETER TIRES:

 

# > 19.5 INCH RIM DIAMETER

 

 

# ≤14 INCH

AND ≤44 INCH AG

TIRES:

 

 

 

 

TIRES:

 

 

TIRES:

 

CERTIFICATION: I CERTIFY THAT THE INFORMATION PROVIDED IN THIS SECTION IS TRUE AND CORRECT AND THAT TIRES IN THE NUMBERS

SHOWN WERE PICKED UP FROM THE GENERATOR IDENTIFIED ABOVE.

 

 

 

 

 

 

 

 

 

PRINTED NAME OF RESPONSIBLE INDIVIDUAL:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SIGNATURE:

 

 

 

 

 

 

DATE:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DEQ FORM #515-081 (Revised January 2013)

THIS FORM IS TO BE USED FOR THE TRACKING OF ALL TIRES EXCEPT THOSE TRANPSORTED DIRECTLY TO A PERMITTED USED TIRE RECYCLING FACILITY WHO IS SEEKING REIMBURSEMENT FROM THE OKLAHOMA USED TIRE RECYCLING INDEMNITY FUND.

Instructions-

Manifests must be printed on appropriate forms in accordance with OAC 252:515-21-51 (a)(b)(c). A copy of the form is to be given to the generator; if applicable, a copy should be attached to the used tire reimbursement manifest when waste tires are picked up from the primary hauler and delivered to a permitted used tire recycling facility; a copy should be retained by the primary hauler or final recipient. Color coding is optional.

Section I. Section I is to be completed and signed by the generator (i.e., tire dealer or other used tire generator).

Section II. Section II is to be completed and signed by the primary hauler or final recipient.

The final recipient of the tires must (within 30 days) return a copy of the completed manifest to the generator.

All parties must retain their copy of the manifest for a minimum of five years.

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