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OCT-1 -?005iFRl 1?. 1 jF� a0836088a5 P, 001. 00 <br /> 900 aerokee Ln.#i --- <br /> LOLII CA 95240 Manifest Number, <br /> ' (2096 333.8442 ;T — } <br /> yrlllbe r�nraac►+sd,onil lin Ide: ' <br /> C./!' ` "CtWMB v+in oantact fhe eigner(sy of+nis termer thb tiddresa . <br /> cusmimms ORDER NO. r'MONE OyTC -. ...,.••• . <br /> :i <br /> ��^ '.p-LEASE�:PfIINT*IRM GY:. <br /> HAME <br /> WL <br /> SOLD BY CASH C.O.D, CIrARGC IONA= ImosE.rim.; PAID OUT <br /> OTY. DESCRIPT IN PRICE AMOUNT I.l" },.+ �'1 .i� I'L-- <br /> t <br /> rHa xam <br /> uler.Eptlon(!f appncatiie) <br /> omment,.O LEA Cx <br /> ❑Go .. <br /> � vempf - ' <br /> ---- <br /> Q Agriculture-:❑Common Carrlorl <br /> Bock Haul <br /> j Indicate.(it appubaeio) <br /> In Transit:•'❑Unregistered Hpuler <br /> nd coead, M addition,I i m.aware that hdslricallon of this <br /> ►upllc Regoureft Code tlecuori 42960 and inoy'towlt ln'ciuil <br /> p.public RBaourcej Code•secuon 42992.-, , <br /> o�p`� � • � Date <br /> t.le It -. - .... .. E, ENERAT BRZA =USS FACIkIT11`. <br /> "LP—Ld EPRlNTE.,f=1RMLY,i <br /> MI: t _ '9 Bushiest phone.(ihcludo area coda): <br /> a, Ip Code :. � ' •- . ' - Address same as Healer <br /> No Warranty On Used Tlres' TAX ; I <br /> EJCliange Ot Ad'drere <br /> ry LT-• T� <br /> TOTAL POO .p•;.;,� ."y s s .- ` <br /> All cl lIMS and rallumad goods MUST bo aceompa led by this bill. ::„•f G^;` �r-•��c''�`«''” ' "':i <br /> �--l i,,, t ,I <br /> lW To ARorder: CI!Il�lLi O/I it1!RdUn�s� '�` j, ' i,:' �'• ,: <br /> 000.225.8390 or nebs 6om 'l':1.Fr ,y��,•?�, ... ;•. I :'':n• :j�. <br /> i T '•i�u"`It1Fd(§[+Jii[rltleto 1i =' 7 <br /> `titx�irt'a� . <br /> 77!7-7,77- <br /> _.:3.:s...��"�'?'Jli�allVii41�1�`1I�YJ'2iint.'.r.�_�:•w., <br /> Ovaieka Amount 9 i` <br /> ., ... ., � ; t,.: .? „• .': ••' <br /> lo. _ - : '-�' t�[]-Retread/F4tiso";;�'©.Rocyc►e.;:••<'�]�F•yot•;',.;;•pDtspossUCandiflr.� <br /> r <br /> r��+ Othekip ounti <br /> G 7` 'k Airiotitlt: <br /> .I <br /> , <br /> •t <br /> N. <br /> { <br /> .3 <br /> CLI <br /> j 1 <br /> 1 eenrly that under pgnWly r perJury under lhe�laws of ilia state of caldom that the into nation pl0vlded above Is true and correeL In edonton:I arn.awam that 1"i bon at psis. <br /> Infotmelion rhay result In it penalties up to S25,goo per day,per viotallor or administrtltive penalties ilp m 35,000 per violation per day ae degC,tDed!n Public Reseureas Code. <br /> section 4296+2 r• r <br /> Repreaentatiire amo(print) <br /> Representative's M01 naturt� Date. 2s�e7'.; <br /> 'Toll Free 1-866-696-96001 '.www:ciwmb:ca.gov/Tires/ . ' : . . ,■ <br /> wilts:CIWMB Copy Pink:Tire 4eolor/Qenaratorl llee,Fottllty Copy Yelloyr <br /> .Remove to stub 2. Fold I heli al fold Itne 3. Remove adhesive strlp 4. Adhere remalni ft stub.:;, <br /> .....�....r, .. ] ni en ur inrr•rf--- <br /> nA Av1T'OCRgA�/c TYIQ.Q1'l1D <br />