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GOLDEN BY-PRODUCTS d.ba SCRAP TIRE COMPANY P.O. BOX 1 / 13000 NEWPORT RD. INVOICE e ; BALLICO, CA 95303 (209) 668-4855 EDT TRIP LOG#: .1003314- 1.0/07/2011 ;1 H B EDT MANIFEST#: 1003314- 00078418 DATE DRIVERS INIT RUN#, SHIP TO: ACCT#: DIAFOOD BILL TO- TERMS: NET30 DIAMOND FOODS, INC DIAMOND FOODS, INC. 1050 S. DIAMOND ST. P.O. BOX 1727 . STOCKTON, CA 95205' STOCKTON,. CA 95201 TPID# 1107191-01 ,' PHONE: (209)969-3136 PHONE: (209)467-6764 P.O. #28129 HAULER/SHIP VIA: GOLDEN BY-PRODUCTS 13000 NEWPORT RD. BALLICO CA 1 C,/ 1 STATE TRUCK#: C' r / LIC PLATE#: t .l U f l� DECAL#: i j -Q q 390 HAULER EXEMPTION: GOVT LEA EXEMPT a COMMON CARRIER UNREGISTERED HAULER SPECIAL INSTRUCTIONS, TRAILER: PU DEL TYPE COUNT U/MUNIT'PRICE EXTENDED AMOUNT 45'.TRAILER SERVICE-105 CU YDS 1.0000. EA.t.:. 800.00 800.00 PLEASE PAY FROM THIS INVOICE -NO OTHER INVOICES:WILL BE SENTI. Invoices over 30 days are subject to a late fee of.1 1/20/6'p&month, which is 18%annually, or a minimum,of$1.00 per month. :TOTAL 800.00 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 falsification of this information 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 Public,Resmrces Code section 42962. Facility Representatives Name(Print). v Facility Representatry s itn ure'/ of .Date { CHARGE ❑ PAID CK# f WEIGHT CERT .NET VVT 1.00 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,1 am aware that falsification of this information may result in suspension,revocation,or denial of renewal of the Waste Tire Hauler Registration pursuant to Public'.Resources 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 Public Resources�Coode section 42962. // ee nPY Driver's Name(Print) Driver's Signature Date Confidentiality Claim (applicable to all parties listed on above): The information,provided in Part I,Part II,and Part III of this form should be considered ��o DarQT 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. Electronic Reporting to CIWMB: Golden 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. Customer.