Vermont Waste Transportation Vehicle Report Form
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1
2MAIL ALL COMPLETED, ORIGINAL FORMS TO:
Department of Environmental Conservation
Waste Management & Prevention Division
State of Vermont
Attn: Cheryl Hamilton
Agency of Natural Resources
1 National Life Drive, Davis 1, Montpelier, VT 05620-3704
Main Tel: # (802) 828-1138
Telephone: (802) 522-5949
Email: Cheryl.Hamilton@vermont.gov
VERMONT WASTE TRANSPORTATION VEHICLE REPORT FORM
----This Vehicle Report Form is Valid July 1, 2016 through June 30, 2017----
Please review the first three boxes below to determine which applications / forms you will need to mail to us.
Applications / Forms - go to the following link:
Check ONLY ONE of the following boxes and provide the proper application(s) / form(s) with a check to the address above.
☐
☐
☐
PERMIT (every 5-year’s)
ANNUAL RENEWAL
MODIFICATION
st
New applicants or Expired Permits. Please use
Renew your permit each year by May 1
.
To add vehicles anytime. Please use
the following forms, and include a check.
Please use the following forms, and include
the following form and include a check.
Vehicle Report Form
Vehicle Report Form
a check.
Vehicle Report Form
Business Disclosure Statement
A check (see fee’s below)
Annual Statement
Personal History Disclosure
A check (see fee’s below)
A check (see fee’s below)
Non-hazardous waste haulers transporting materials out-of-state for disposal must complete a Franchise Tax form
and send it directly to the Department of Taxes on a quarterly basis, which can be found at the following link:
Send a “copy” of the completed Franchise Tax form to the address at
the top of this application.
Identify the destination facility(ies): _______________________________________________________________
HAULER / TRANSPORTER CONTACT INFORMATION
Name of Business:
Contact Name:
Title:
Mailing Address:
City/Town:
State:
Zip:
Telephone: (
)
Email Address:
VEHICLE FEES
Description of specific types of hauler vehicles and fees:
Qty.
Fee
Total Cost
$125 for ALL Hazardous Waste Haulers, for each vehicle, regardless of size
$125
$
2 axle = $50 – (non-hazardous) for: each pickup, each stake-body, each utility trailer
$50
$
3 or 4 axle = $75 - (non-hazardous) for: each packer, each dump, each roll-off, or each box truck
$75
$
All others = $100 - (non-hazardous) for each tractor, or each trailer. Each one must be permitted.
$100
$
Checks are made payable to: Treasurer, State of Vermont
Total
$
Check the boxes below indicating all
:
wastes that you are transporting
☐ Solid Waste
☐ Hazardous Waste
☐ C&D
☐ Medical
☐ Organics
☐ Recyclables
☐ Scrap Metal
☐ Septage
☐ Tires
☐ Wastewater Treatment Sludge
☐ Bio solids
☐ Other-Describe:
Go to page 2 of this application.
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