Florida Department of Environmental Protection Waste Tire Collector Registration Notification Expires April 1, 2018 Monday , July 10,2017 The Company listed below has registered with the Department as a Waste Tire Collector in accordance with Chapter 62-711.520, F.A.C., and registration decals have been issued to the vehicles listed below. These decals are valid until April 1, 2018 unless revoked. Decals must be affixed to the assigned vehicle on the driver's side door of that vehicle. Decals are $35.00 each. For further information call "Waste Tires" at 850-245-8756. _______________________________________________________________________________________________________ WACS ID: No 00097482 Decal # Name: YR JOMAH TRADING, INC. MAKE TYPE DBA: GREEN TIRE DISPOSAL VIN # TAG # ST Owner # _______________________________________________________________________________________________________ 1 1740 1998 DODG PK 3B7HC13Y1WG245895 EBYP57 FL 2 1741 1998 FORD PK 2FTZX0763WCB04531 IAHX05 FL 3 1742 1999 MAZD PK 4F4YR12C0XTM30357 HQBL12 FL Florida Department of Environmental Protection Bob Martinez Center 2600 Blair Stone Road Tallahassee, Florida 32399-2400 DEP Form # 62-701.900(18), F.A.C. Form Title Waste Tire Collector Registration Application Effective Date: January 6, 2010 DEP Application No.____________________________ (Completed by DEP) WASTE TIRE COLLECTOR REGISTRATION APPLICATION Pursuant to Rule 62-711.520, Florida Administrative Code, to obtain a waste tire collector registration number and approval to transport waste tires, a collector shall submit the following information on this form to the Department. □ For Hire Collector Type of Collector: □ Not For Hire □ Registered with ICC □ Government Entity Part I- Business Information: 1. JOMAH TRADING, INC. Business name of collector: WACS ID Number: 97482 (assigned by Department) 2. Other business names of collector (DBA's): 3. Mailing address of collector: City 4. 18200 S Dixie Hwy Miami FL State Street address of collector: City GREEN TIRE DISPOSAL Zip 33157 18200 S Dixie Hwy Miami County Miami-Dade (305) 278-4632 State FL Zip 33157 kathy@mrgomatires.com 5. Telephone number of collector: 6. Federal Employer Identification number (FEID) of Collector: 7. Have any enforcement actions been taken by the Department or other governmental agency against the applicant for violation of Department rules relating to the collection or disposal of waste tires? This includes any Complaint, Notice of Violation, revocation or suspension of a registration, as well as any Consent Order in which a violation of Department rules is admitted. It does not include a Warning Letter, Warning Notice, Notice of Noncompliance, or other similar document which does not constitute agency action. □ Yes □ ✔ No Email address: If yes, attach a history and description of the enforcement actions. Part II- Person in charge of Waste Tire Collection Operations: N/A 1. Name of Person in charge of Waste Tire Collection Operations: 2. Date of Birth of Person in charge of Waste Tire Collection Operations: N/A Corporations also complete Part III. GREEN TIRE DISPOSAL 1. Corporation Name: 2. Corporation Filing Date: 3. Corporation Officers: 4. Florida Resident Agent of Corporation: DEP FORM 62-701.900(18) Effective January 6, 2010 06/28/2006 State of Incorporation: N/A JEAN PAUL COHEN Page 1 of 2 FL WACS ID: Part IV- Collection and Disposal Information: 1. List all known locations where you will be collecting waste tires (attach additional sheets if necessary) Name Address City State See attached sheet. 2. List all known locations where you will be delivering or depositing waste tires for recycling or disposal (attach additional sheets if necessary): Name Address City State See attached sheet. Part V.- Vehicles to be Registered: 3 1. Number of vehicles to be used: 2. Vehicles registration information: a. A legible copy of the current vehicle registration is required for each vehicle registered. The registration must show State of registration, year, make, tag number, vehicle identification number, and registered owner. b. IF the vehicle is not owned by the collector, an authorization from the vehicle owner for the vehicle to be registered for waste tire collection must be attached to this application. c. IF Common Carrier, list Interstate Commerce Commission (ICC) authority number for the company: Part VI. Registration Fee Information 1. Waste tire collector registration status: □ New □✔ Renewal If registration is a renewal, list previous registration number(s) 2. N/A Attach payment for registration fees pursuant to Rule 62-711.520(11), F.A.C. Number of vehicles # 3 x $35 = $ 105 = Amount of Payment Part VII. Certification To the best of my knowledge and belief, I certify the information provided in this application is true, accurate, and correct. I have attached all documents and/or authorizations that are required. Kathy Cohen Kathy Cohen 07/03/2017 Print Name of Authorized Agent Signature of Authorized Agent Date Mail completed form to: Florida Department of Environmental Protection Division of Waste Management / Tires 2600 Blair Stone Road, MS 4550 Tallahassee, Florida 32399-2400 DEP FORM 62-701.900(18) Effective January 6, 2010 Page 2 of 2 Florida Department of Environmental Protection Bob Martinez Center 2600 Blair Stone Road Tallahassee, Florida 32399-2400 Rick Scott Governor Carlos Lopez-Cantera Lt. Governor Noah Valenstein Secretary Waste Tire Collector Registration Collection and Disposal Locations Attachment WACS ID: 97482 Collector Name: JOMAH TRADING, INC. Year: 2016 Part IV - Collection and Disposal Information: 1. List all known locations where you will be collecting waste tires Name Mr goma tIRES Mrgoma Tires Address 3251 NW 27TH AVE 202825 nw 2nd Ave City MIAMI miami State FL fl 2. List all known locations where you will be delivering or depositing waste tires for recycling or disposal WACS ID 99254 Name & Details AMERICAN TIRE RECYCLING GROUP, LLC ~ 3551 NW 116th St ~ Miami ~ 33167 State Florida D IVISION Department of State / Division of Corporations / Search Records / Detail By Document Number / Detail by Entity Name Florida Profit Corporation JOMAH TRADING, INC. Filing Information Document Number P06000087539 FEI/EIN Number 20-5134381 Date Filed 06/28/2006 State FL Status ACTIVE Last Event AMENDMENT Event Date Filed 07/01/2014 Event Effective Date NONE Principal Address 18200 S DIXIE HWY MIAMI, FL 33157 Changed: 04/29/2013 Mailing Address 18200 S DIXIE HWY MIAMI, FL 33157 Changed: 04/29/2013 Registered Agent Name & Address JEAN, COHEN P 18200 S DIXIE HWY MIAMI, FL 33157 Name Changed: 04/08/2008 Address Changed: 04/29/2013 Officer/Director Detail Name & Address Title P COHEN, JEAN P 18200 S DIXIE HWY MIAMI, FL 33157 OF C ORPORATIONS Title S COHEN, KATHERINE 18200 S DIXIE HWY MIAMI, FL 33157 Annual Reports Report Year Filed Date 2015 02/09/2015 2016 03/28/2016 2017 04/17/2017 Document Images 04/17/2017 -- ANNUAL REPORT View image in PDF format 03/28/2016 -- ANNUAL REPORT View image in PDF format 02/09/2015 -- ANNUAL REPORT View image in PDF format 07/01/2014 -- Amendment View image in PDF format 04/30/2014 -- ANNUAL REPORT View image in PDF format 08/08/2013 -- Amendment View image in PDF format 04/29/2013 -- ANNUAL REPORT View image in PDF format 04/10/2012 -- ANNUAL REPORT View image in PDF format 07/12/2011 -- Amendment View image in PDF format 04/29/2011 -- ANNUAL REPORT View image in PDF format 03/24/2010 -- ANNUAL REPORT View image in PDF format 08/31/2009 -- ANNUAL REPORT View image in PDF format 07/14/2009 -- Amendment View image in PDF format 04/08/2008 -- ANNUAL REPORT View image in PDF format 05/14/2007 -- ANNUAL REPORT View image in PDF format 06/28/2006 -- Domestic Profit View image in PDF format Florida Department of State, Division of Corporations DEP Form # 62-701.900(22), F.A.C. Florida Department of Environmental Protection Form Title:Waste Tire Collector Annual Report Effective Date: January 6, 2010 DEP Application No. _____________________ (Completed by DEP) Bob Martinez Center 2600 Blair Stone Road Tallahassee, Florida 32399-2400 WASTE TIRE COLLECTOR ANNUAL REPORT 2016 (For Calendar Year Ending ) Pursuant to Rule 62-711.520, Florida Administrative Code, waste tire collectors are required to submit the following information to the Department by March 1 of each year. The annual report must be submitted along with the annual registration renewal application and registration fee as a condition of holding a waste tire collector registration number. 1. Business name: JOMAH TRADING, INC. 2. Business mailing address: WACS ID Number: 97482 (assigned by Department) 18200 S Dixie Hwy City: State: 3. Business street address: State: 4. Business telephone: Zip: 33157 Zip: 33157 18200 S Dixie Hwy Miami City: FL (305) 278-4632 FL Email address: kathy@mrgomatires.com 5. Total quantity of waste tires, expressed in tons, collected or generated during the calendar year 3 (assume100 tires per ton or 10 tires per cubic yard): tons tires 6. Describe how the waste tires collected were disposed of during the calendar year, reported in tons. (assume 100 passenger tires per ton, 20 truck tires per ton.) A. List total quantity of waste tires sold as used tires. A. B. List quantity of waste tire casings sold. B. 1 0 tons tires tons tires C. List quantity of waste tires hauled off by other Waste Tire Collectors. Attach additional sheets, if necessary. Name of Other Collector Collector Registration Number Quantity in tons See attached sheet. C. D. 1 tons tires List the facilities where waste tires were deposited for disposal or recycling and the quantity disposed at each location. Attach additional sheets, if necessary. Name of Facility Address / City / State Quantity in tons See attached sheet. D. TOTAL Tires sold or deposited for disposal or recycling DEP FORM 62-701.900(22) Effective January 6, 2010 Page 1 of 2 A+B+C+D 1 3 tons tires tons tires WACS ID: 97482 7. Explain any differences between Waste Tires Collected (item 5) and Waste Tires Deposited (item 6): 8. Waste tire collector registration number(s): N/A Jean Cohen (305) 278-4632 9. Authorized person preparing report: 10. Telephone number of person preparing report: 11. Certification: To the best of my knowledge and belief, I certify the information provided in this report is true, accurate and correct. Kathy Cohen Kathy Cohen Print Name of Authorized Agent Signature of Authorized Agent Mail completed form to: Florida Department of Environmental Protection Division of Waste Management / Tires 2600 Blair Stone Road, MS 4550 Tallahassee, Florida 32399-2400 DEP FORM 62-701.900(22) Effective January 6, 2010 Page 2 of 2 07/03/2017 Date Florida Department of Environmental Protection Bob Martinez Center 2600 Blair Stone Road Tallahassee, Florida 32399-2400 Rick Scott Governor Carlos Lopez-Cantera Lt. Governor Noah Valenstein Secretary Wate Tire Collector Annual Report Hauled & Disposal Locations Attachment WACS ID: 97482 Collector Name: JOMAH TRADING, INC. Year: 2016 6. Describe how the waste tires collected were disposed of during the calendar year, reported in tons. Assume 100 passenger tires per ton, 20 truck tires per ton.) C. List quantity of waste tires hauled off by other Waste Tire Collectors. Name WACS ID YAQUELIN SANTANA DE 103461 ORTOLANI County Quantity MIAMI-DADE 1 D. List the facilities where waste tires were deposited for disposal or recycling and the quantity disposed at each location. WACS ID Name & Details State Quantity AMERICAN TIRE RECYCLING GROUP, LLC ~ 99254 Florida 1 3551 NW 116th St ~ Miami ~ 33167 Thigpen, Hope From: Sent: To: Subject: Attachments: no-reply@dep.state.fl.us Monday, July 3, 2017 11:36 AM Waste Registration Waste Tire Collector Registration - 97482 ca5cbcf9ae29b71234502ada6378786.pdf; e744bba36967a45d911ceae369d3948.pdf Florida Department of Environmental Protection Bob Martinez Center 2600 Blair Stone Road Tallahassee, Florida 32399-2400 Rick Scott Governor Carlos Lopez-Cantera Lt. Governor Noah Valenstein Secretary Waste Tire Collector Registration Confirmation of Submission July 03, 2017 Kathy Cohen has completed the registration process for the facility listed as: WACS ID: 97482 JOMAH TRADING, INC. 18200 S Dixie Hwy Miami, FL 33157 County: MIAMI‐DADE Attached is a copy of the application and a copy of the annual report (if available). They reported: Tonnage Remaining: 0 Tonnage Collected: 3 Tonnage Disposed: 3 New Tonnage Remaining: 0 Copies of each vehicle registration uploaded are located at: http://webapps.dep.state.fl.us/common/ESSA/uploads/205059/Vehicle_Information/COHEN_K_1_07‐03‐2017‐11‐ 08‐46.pdf 1 http://webapps.dep.state.fl.us/common/ESSA/uploads/205059/Vehicle_Information/COHEN_K_1_07‐03‐2017‐11‐ 11‐01.pdf http://webapps.dep.state.fl.us/common/ESSA/uploads/205059/Vehicle_Information/COHEN_K_1_07‐03‐2017‐11‐ 20‐25.pdf 2