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03/01/2005 22:38 FAX <br /> ItP.DL1jjzM.. 1.31 W blrstsrpr,tt <br /> CrrY,ST.zip: sanity,CA► 95 "x. Q Q x ' a a- -L'9 � <br /> PHONE: (209)668-4853 <br /> HAULER SON: UO41T <br /> U Ata ULEA ax�'t UCOMMON CAARM ULTNREGIST' : HAULB <br /> DRNER'S LIC#: <br /> .t verily aha unbar deNat�m 6m*o%awtear%KrA omia*4Wti-ra kdorl%ka .Provtdad+bows+e ftwud vara_roAtl ifflm t am&wan that fniedloesan or this lntarcn rnny rami Yn <br /> Parurmt ronceson,or delved a�rew.t of tn.WaHagar Regi.erason puma i to Puuec Redo mm Code amen42990 end may r_in to ono g -.1uva>I2SAM Ptyoa,asr Yocum q oram <br /> [doom P•r.w.w m x,007 "bAwrrtywoHr +r 4 dib 19aeo+aow Ooda aw dw 42K2 <br /> i, Driver's Signature Date <br /> l?o! PMgjwA i -hugv use vrr <br /> TMOUT CERT A. _ DIET WT: — TONS <br /> For the other half of this tmn on, hauler is also the: IJ Generator UEnd use facility <br /> RA�►N CSTit't4. � - --�' - - - - -- - - +-- - - ------ - ---- -- _. - -- B <br /> OddWo ether had of uRneautitm 1�h I EDT tbodet BlYr VlaolfraL M ett*-v &A.VI"'.. <br /> Cortfidentidtty Clelm(applicable to all les haled on above):The information provided In Port I,Part Ii and Part ul Of tragi form should 150 <br /> conflrlentlal,proprq uq.andlor trade . In eocordanae with Title 14,CCR,t3 &on 17041 etaeq,should any member of tlhe Public r <br /> this intomuition,1 request tat hC1WM9 no act n»at the address and telephone number above. ; <br /> 19eatdVft IRalpadlrtp to Cfwme:Gdd6n _yProducts has been authorized try CIWM8to participate in the Wgste end Used Tire-,/ta.. <br /> IsporgTv Mgr*kftL on behawni of the CU r ttsted on this front,Golden ay-Products will e4ctronfcauy tranemR to CfW S W- <br /> rr¢odfowt fptrrt <br /> tto� ,.tet <br /> r <br /> II <br /> 02/28/05 08- » r._- <br />