Tire Drop Off Log

Tire Drop off Log

Collector Reg #:

Date:

Collector Business

Name:

# of tires by Tire Type

Name

Contact #

Commerical / Residential

PLT

MT

AG/LS

IND

SOTR

MOTR

LOTR

GOTR

Total

Highest Single Delivery :

It is the responsibility of the Collector to ensure that the tires being reported here are eligible to be Claimed as Collected. This log may be maintained by the Collector and made available on request by OTS.