Application For Transfer Of Permit Or Notification Of Name Change
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Florida Department of
DEP Form #: 62-701.900(8), F.A.C.
Form Title: Permit Transfer Form
Environmental Protection
Effective Date: January 6, 2010
Bob Martinez Center
Incorporated in Rule: 62-701.320(11), F.A.C.
2600 Blair Stone Road
Tallahassee, Florida 32399-2400
APPLICATION FOR TRANSFER OF PERMIT OR NOTIFICATION OF NAME CHANGE
GENERAL REQUIREMENT: Permit transfers for Solid Waste Management Facilities shall be permitted in accordance with
Florida Administrative Code (F.A.C.) Rule 62-701.320(11). A transfer of permit is required upon the sale or transfer of a
facility. A transfer of permit is also required if a new or different person takes ownership or control of the facility. A
transfer of permit is not required if the facility or permittee simply changes its name, although the permittee must notify the
Department of such a change. Two copies of this form shall be submitted to the Department District Office having
jurisdiction over the facility for either the Notification of Name Change or Transfer of Permit.
PART I. GENERAL INFORMATION
TO BE COMPLETED BY THE CURRENT PERMITTEE
Permit No. ______________________________ Date Issued: ________________ Date Expires: _______________
Existing Facility Name: _______________________________________ County: _________________________
Facility Location: ____________________________________________ City: ___________________________
(Street or Road – Do Not Use P.O. Box)
Permittee: _________________________________________________________________________________
(Company or Legal Entity Name as Listed on the Permit)
Authorized Representative or Permittee: _________________________________________________________
(Print or Type Name of Person)
Title: _________________________ Email: _____________________________ Telephone: (____) ___________
Mailing address: ______________________________________________________________________________
(Street or P.O. Box)
(City, State and Zip)
PART II. CHECK ALL BOXES THAT APPLY AND COMPLETE AS DIRECTED
□
1.
Permit requires financial assurance documentation. You must attach a copy of documentation to this form
indicating that the financial assurance mechanism has been or will be modified to reflect proposed name changes
(facility or legal entity name) of the current permittee or if the permit is to be transferred, the applicant (proposed
new permittee) must provide new proof of financial assurance. Send original signature financial assurance
documentation with a copy of this form to:
Solid Waste Financial Coordinator
Department of Environmental Protection
2600 Blair Stone Road, MS 4565
Tallahassee, Florida 32399-2400
For further financial assurance information, visit or call the financial
coordinator at 850-245-8732. If box 1 is checked and you believe financial assurance does not need to be
modified, attach an explanation of why no modification is required.
□
2.
The current Permittee (Owner or Operator) will remain the same, however the facility name and / or name of
the permittee (company or legal entity name) will change. Complete Part III.
Northwest District
Northeast District
Central District
Southwest District
South District
Southeast District
160 Governmental Center
7825 Baymeadows Way, Ste. B200
3319 Maguire Blvd., Ste. 232
3804 Coconut Palm Dr.
2295 Victoria Ave., Ste. 364
400 North Congress Ave.
Pensacola, FL 32501-5794
Jacksonville, FL 32256-7590
Orlando, FL 32803-3767
Tampa, FL 33619
Fort Myers, FL 33901-3881
West Palm Beach, FL 33401
850-595-8300
904-807-3300
407-894-7555
813-632-7600
239-332-6975
561-681-6600
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