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�� T� 4554 S. El Dorado St. Nevada 019 Wa WM100035 P.O. Box 83328 Stockton, CA 95206 = == Portland, OR 97283 i Stockton &Sacramento Area(209)234-07 WASTE RECOVERY WEST.INC. 1-877-OLD-TYRE Redding Area (530) 275-1160 [.Hauler ❑Generator ❑End Use Facility Invoice DateT�, I Load Date Phone# Pickup T'�� Delivery Customer Name Acct # '- f i ✓ i Site Street Address "i{i r T -� i i City r� :7 r` 7 ; , State Zlp--` �' 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$25,000 per day,per violation or administrative penalties up to$5,000 per X r ;/I r ,. violation per day as described in Public Resources Code section 42962. P Hauler Exem tion ------ ❑Government []LEA ---------------c—. ❑Agriculture ❑Common Carrier TRUCK# HAULER TRLR LGTH TRLR#'S DRIVER/HELPER MANIFEST# CAS�HARGE 1 LIC PLATE#" DECAL#' LIC'STATE IMPORT ❑"' 't LOCATION' ° CUSTOMER TPID#: \TRIP LOG# - Q 1.,-,- C n^ " .7 EXPORT ❑ LOQUA TITY Description COT YYPP Rate Amount QUANTITY Passenger Tires @ Passenger Tires on rim @ _Manifest:-Pee---- 1.50 _1,50 Customer Signature ' 1 _- Total Amount$ I certify that under penalty of perjui}i under the laws of the State of Califorriia-thar'ihe information provided above is true and cor- rect.In addition,I am aware that falsification of this information may result in ciwtil,penalties up to$25,000 per day,per violation or administrative penalties up to$5,000 per violation per day as described in Public Resources Code section 42962. INVOICE C ') LOCATION TPID 1003974 �..®'., PLEASE REMIT TO: 4554 S. El Dorado St. Nevada 019 __ =non __ P.O. Box 83328 Stockton, CA 95206 Wa WM100035 _ _ z_ Portland, OR 97283 Stockton &Sacramento Area (209)234-0700 WASTE RECOVERY WEST.INC. 1-877-OLD-TYRE Redding Area(530) 275-1160 Q,Hauler ❑Generator ❑End Use Facility Invoice Date Load Date +; ! 7 Phone# ❑--{{Dleliv� _ S i - .i E- y Customer Name / �' T , i n i/ ._ r. �^ y Acct #------------------------- Site Street Address ';�� ,�$, City J State Zip_ =�_ -__ ✓ fes.a 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$25,000 per day,per violation or administrative penalties up to$5,000 per x—fs. violation per day as described in Pubfic Resources Code section 42962. Hauler Exemption [:]Government [:]LEA i=''-->•`"7----r--'�� []Agriculture ❑Common Carrier TRUCK# HAULER TRLR LGTH TRLR#'S DRIVER/HELPER MANIFEST# ASR/CHARGE LIC PLATE#` DECAL# LIC STATE' IMPORT ❑' LOCATION' CUSTOMER TPID#: TRIP LOG# r ? - EXPORT ❑ LOADAMOUIPT' Description � TYPE Rate Amount QUANTITY - Passenger Tires @ �I Passenger Tires on rim @ L 1 Manifest Fee 1.50 - 1.50 " r� Customer Signature - Total Amount$ I certify that undoi'perialry of perjury undcc-tlie laws of the State of California that the information provided above is true and cor- rect.In addition,I am aware that falsification of this information may result in civil penalties up to$25,000 per day,per violation or 711466 '� pia -�- administrative penalties up to$5,000 per violation per day as described in Public Resources Code section 42962. INVOICE C C i1 11 4 66"6',