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LiCAT10N TPID 10^1974 ,A/RS' ' w PLEASE REMIT TO 4554 S. El Dorado St. Nevar F O. Box 83328 j Stockton, CA 95206 Wa WM 15 = __ _''_: -==..3? LOVED ortland, OR 97283 Stockton &Sacramento Area(209)234-0700 WASTE RECOVERY WEST.INC. 1-877-OLD-TYRE Redding Area(530)275-1160 QHauler El Generator ❑End Use Facility OCT 31 2013 Invoice Date !r' 1 — ! Load Date.//2 ';��– 1 Phone # ❑Pickup v EfVV1R01�► El Delivery Customer Name'- Say ,L n. l i �i 1I ti F MMull u 'n.� MITH __�_ Site Street Address f�,s l�F�i i in �n �1 1,/City S 7,' r 7C r) /SttRtecPs.? Zip y— DRIVER I certify that under penalty of perjury under the laws of the State of California that the information provided is true and correct.In addition,I 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 525,000 per day,per violation or administrative penalties up to$5,000 per X___ /'( }y,•t r,i %, _� violation per day as described in Public Resources Code section 42962. Hauler Exemption ❑Government ❑LEA / ❑Agriculture ❑Cgmmon Carrier TRUCK# HAULEfl TRLRIGTH TRLR#'S ;, DRIVER/HELPER MANIFEST# ASH�CHARGE LIC PLATE-* �r DECAL# LIC STATE IMPORT Q - LOCATION CUSTOMER TPID#: TRIP LOG# f r 7 1 Tr EXPORT ❑ LOAD NT QUATITY AN Description ,1..OADTYPE 7C-:T Y P Rate Amount TY - - �j r{ Passenger Tires @ Passenger Tires on rim @ Manifest Fee 1.50 4--.550- Customer Signature Total Amount$ '`"•''• I certify that under penalty of perjury under the'laws of the State of California that the information provided above is true and cor- rect.In addition,I am aware-[Fiat 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 Resources Code section 42962. INVOICE C 178- 9,67 LOCATION TPID 1003974 '.,�'■. PLEASE REMIT TO: 4554 S. El Dorado St. Nevada 019 __ 'Ma"Mm P.O. Box 83328 Wa WMI00035 Stockton, CA 95206 ' Portland, OR 97283 Stockton &Sacramento Area (209) 234-0700 WASTE RECOVERY WEST.INC. 1-877-OLD-TYRE Redding Area (530) 275-1160 ZHauler El Generator ❑End Use Facility Invoice Date >'C' Load Date Phone# El Pickup ❑Delivery Customer Name �yP-) Q C2 Y 41,_,_�' s' ' ` Acct#________�_�__ _ Site Street Address I City !� ?0T;fir A State Zi r DRIVER I certify that under penalty of perjury under the laws of the State of California that the information provided is true and correct.In addition,I am / i 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$5,000 per X rJ/- violation per day as described in Public Resources Code section 42962. Hauler Exemption ❑Government (:)LEA —1 ❑Agriculture ❑Common Carrier TRUCK# HAULER TRLR LGTH TRLR#'S DRIVER/HELPER MANIFEST# �SHICHARGE LIC PLATE# DECAL# LIC STATE IMPORT ❑ LOCATION CUSTOMER TPID#: TRIP LOG# EXPORT ❑ LOAD AMOUNT Description LOAD TYPE Rate Amount QUANTITY C-T-Y-P Passenger Tires @ Passenger Tires on rim @ 1 Manifest Fee 1.50 ____J.50._ Customer Signature !��-�^ .= Total Amount$ _ I certify that under penalty of perjuryynfla the laws of the State of California that the information provided above is true and cor- rect.In addition,I am aware asfalsification of this information may result in civil penalties up to$25,000 per day,per violation or '? A administrative penalties up to$5,000 per violation per day as described in Public Resources Code section 42962. INVOICE C 17 S i.