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<br /> 02:28i05 09:20 FAX 209 6674854 G,B.P- [�J003
<br /> WASTE & USED FIRE 11MNIFEST/RECEIPT
<br /> E9 TRjT L0G#- 10038, _ -t 1_ �- _- , WT MAArLrj?`TST - 10033,14-0 008875
<br /> DATE pWN INTL RUN.At INVOICE#
<br /> 1
<br /> Pal:1:F,a,.0jty,1nfpnnari,,w (.4c al PhImical JCiiC tion affacililjwo A[�, k yp �t0_
<br /> Check ane'. PICK Ti I FROm&GENERATOR L DELIVERY TO AN ENI] USE FACILITY
<br /> If gnpticable: Uingnort �JExoort bnp/Exp Location:
<br /> 'u4ME.• ►T O LA�'h o� GOI I3EN/STC ACCTiI< If �L!
<br /> I ADDRESS: CE11
<br /> ADDRESS: 1 S1 S S 1 Z'''' S� 99Z.-uvyl TIREpIZ(�G�A?�I ID'. 4—
<br /> Cli ST,zu>: C �� I �,_v ;
<br /> SITE SUFFIX: V t
<br /> PHONE: 'L q 9 _ja
<br /> 13 ek T IL TRAILER#: P/U DEL
<br /> Part 2: Load Information TYPE COUNT RATE DOLLARS
<br /> F.USED TIRES
<br /> ,NVHOL.E WASTE TIRES Passenger �S'� J Z s - 01 S Intended Use:
<br /> Lfwob,= Truck Z 7 . �'� = l y °a LRE:READ
<br /> /WHOLE TME C'OUN-I (C) Tractor Q =
<br /> ji,"MC YARLD Y) Cath r �dFLI
<br /> f�,1 M S Z- �� ga J� YCLE
<br /> F I
<br /> !QvETGIN LHS(p) Trailer ® = � uDISFOSAL
<br /> I_!WEIGHH T IN TONS(T) TOTAL -
<br /> I certlty I17et Under punally of penury under the 16*8 oft %State of Calliomis that the irtl0rmelion pruv.ded above is true end correct.M addition,I am ewers hart talsirtcation of tMa Informadw may reaves In
<br /> .rv"oa(tlwifntn.S?St OrAty,Dar-V{nMllm n E��)ga- Ive n."'W_up
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<br /> 000 pe;violdk+n ppw dives P Heenu Codes i or 42862
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<br /> FNility Rrrnm4rtlr�tiw.:a_r�lame iCPtitvl Fecilrty Rgerrseutative's Signaturo _11-h
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<br /> Darr 3- �G'�iTICt'TCtiE'l�^7aLiE1P
<br /> TROUK : _ $ 9 I rE: Cts
<br /> NAME; Golden By-Product,Inc.
<br /> rtDDRBSS I n 0. Bcr,t LTC AT ATE.#' � ]a ja ,"� ±A .n J_
<br /> ADDR855: 13000 Newport Road
<br /> I CITY,ST,ZIP: 881fico,CA 95303 DECAL#- �, p
<br /> PHONE: (209)668-4855
<br /> JUNREGISTERED HAULEF
<br /> HAULER EXEMPTION: l;cp �' Ac �L1=4 EX�1PT LJCof�ttrtol�cAftlt>Eg DRIVER'S LIC#:
<br /> (^,Aft[tlj thll rPtYV.¢grWbl nf.�fi/A/ty uw1K-r7fA IawaN;h Fatale f r.gWama ftL�tha(MgRnettM.¢rovlderi ain,v e b hue&mi awtea.In edditk n,l am awe re laid Wat ication at this Irtf mutton rney vise lttn ai
<br /> pension.mvvcmlon,or denial of renewal at me Waste T1 p Hauler RsgMtraaon pursueM fo Public Re—urcoa Code teUlon 42mo and may result In oio panahles up 10 525,000 par day,per violation or adm:
<br /> lrataalrwnitlaxua+inSdtlMnwrwaiaaar�—,vmr,o mtp"Jr,EbJA4,Ftcwm��dv-,%"4w 42.
<br /> Dtivcr'a Dame WntjD
<br /> river's Sfgtttttute ate
<br /> �'�xrt a, 3iYter hnfm� r ' o r -Pnnrtn, in-rh_ruse v,-c�nf
<br /> kVFJGHT CERT#.• NET WT• TONS
<br /> _For the other half of this tranuctii in, hauler is also the: LGenerator L]Rnd use facility
<br /> M(ANTE'F—ST#'-M_ ` _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _- B
<br /> Golden'v other half cf transaction 0 Dither T Hauler ED'i.Ianirest 0 Paper Maniftat 0 in place of Guldens RDT Manifest 0 for: (circle one) Pick-vp Druyttry
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<br /> Confidentiality Clalrn(appllcable to all pa es listed on above): The Information provided in Pan I,Part 11 and Part III of this form should be considered
<br /> Uutff6enyal,prnpri�rgry,Hnwor`trade ?n au mrdance wffn Title 14,CCR.miction 17Drt1 et-seq,should�ry membyr,rit the pddlc requs�t tSSecfoeute t
<br /> this Intortnetion, reque6t that CIWMB cant ct me at the address and telaohnne rn,mtxtr nhnva
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