COMPLIANCE INFO - Laserfiche WebLink

Home Browse Search

EN BY-PRODUCO dba SCRAP `IRE COMPAY P.O. BOX 1 113000 NEWPORT RD. INVOICE BALLICO, CA 95303 (209) 668-4855 EDT TRIP LOG#: 1003314- 03/26/2014 ,1Z 1 EDT MANIFEST* 1003314- 00095264 DATE DRIVERS INIT RUN e SHIP TO: ACCT#: TRACHEV BILL TO: TERMS: NET30 TRACY CHEVROLET TRACY CHEVROLET 3400 AUTO PLAZA WAY 3400 AUTO PLAZA WAY TRACY, CA 95304 TRACY, CA 95304 TPID# 1538688-01 Loneq PHONE: (209) 8354500 PHONE: 209 835-4500 LER/SHIP VIA: GOLDEN BY-PRODUCTS 13000 NEWPORT RD. BALLICO STATECA [HAU RUCK#: GBPO87 LIC PLATE#: CA 8W56341 DECAL#: 14-04528 HAULER EXEMPTION: GOVT [:] LEA EXEMPT F]COMMON CARRIER F-I UNREGISTERED HAULER TRAILER: PU DEL SPECIAL INSTRUCTIONS: TYPE OUNT U/M UNIT PRICE EXTENDED AMOUNT PASSENGER TIRE-COUNT EA 1.25 TRUCK TIRE-COUNT 1' EA 5.50 CAR RIM-COUNT 7 EACH 1.00 z r-�rr PLEASE PAY FROM THIS INVOICE-NO OTHER INVOICES WILL BE SENTI Invoices over 30 days are subject to a late fee of 1 1/2% per month, which is 18%annually,or a minimum of$1.00 per month. TOTAL 1 ' I certify that under penalty of perjury under the laws of the State of California that the information provided aMpery addition�bR,�iources rare that falsification of this information may result in civil penalties up to 525,000 per day violation or administrative penalties up to 55,000 pered in PuCode section 4 962. Facility Representative's Nam4(Print) Facility Representative's signature Date CHARGE PAID CK# WEIGHT CERT NET WT TONS I certify that under Penalty of perjury under the laws of the state of California that the information provided above is true and correct. In addition,I am aware that fats eation of this information may result in suspension,revocation,or denial of renewal of the Waste Tire Hauler Registration pursuant to Publioesources Code section 42960 and may result in civil penalties up to $25,000 per day per violation or administrative penalties up to$5,000 per violation per day,as described in Pu4Hc tfesources Coda section 42962. Driver's Name(Print) Drtvef'a Signature Date Confidentiality Claim (applicabte to all parties listed on above): The Information provided in Part t,Part II,and Part III of this form should be considered Dotpr confidential,proprietary,and/or trade secret. In accordance with Title 14,CCR,Section 17041 et.seq,should any member of the public request disclosure of this information,I request that CIWMB contact me at the address and telephone number above. 0 Electronic Reporting to CIWMB: Gowen By-Products has been authorized by CIWMB to participate in the Waste and Used Tire Manifest EDT electronic reporting program. On behalf of the customer listed on this form,Golden By-Products will electronically transmit to CIWMB all required information from this manifest form. i Customer