(1) An application for partial reimbursement shall be in the format prescribed by the local health department and shall include: (a) the recycler's name and a brief description of the recycler's business; (b) the quantity, in tons, of waste tires recycled or used in a beneficial use; (c) originals or copies of log books, receipts, bills of lading, or other similar documents to establish the tonnage of waste tires recycled or used in a beneficial use; (d) a description of how the waste tires were recycled; (e) proof that is satisfactory to the local health department that the waste tires were recycled or used in a beneficial use; and (f) the affidavit of the recycler warranting that the recycled waste tires or waste tires used for a beneficial use for which reimbursement is sought meet the requirements of Subsection 19-6-809(4).

(a) the recycler's name and a brief description of the recycler's business;

(b) the quantity, in tons, of waste tires recycled or used in a beneficial use;

(c) originals or copies of log books, receipts, bills of lading, or other similar documents to establish the tonnage of waste tires recycled or used in a beneficial use;

(d) a description of how the waste tires were recycled;

(e) proof that is satisfactory to the local health department that the waste tires were recycled or used in a beneficial use; and

(f) the affidavit of the recycler warranting that the recycled waste tires or waste tires used for a beneficial use for which reimbursement is sought meet the requirements of Subsection 19-6-809(4).

(2) In addition to any other penalty imposed under Section 19-6-821 or 19-6-822 or by any other law, any person who knowingly or intentionally provides false information to the local health department under Subsection (1): (a) is ineligible to receive any further reimbursement under this part; and (b) shall return to the Division of Finance any reimbursement previously received for deposit in the fund.

(a) is ineligible to receive any further reimbursement under this part; and

(b) shall return to the Division of Finance any reimbursement previously received for deposit in the fund.