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- laIalPse <br /> I� j <br /> I <br /> Al <br /> 02/28/05 09:19 FAX 20 6674854 G.B.P. <br /> 1002 <br /> GOLDEN 13Y-nPR I DuryS WASTE & USED TIRE _MANj[FFST/RECE] r <br /> EDT TRIP LOG# 1003314 /��rJ __� _ EDT MAN 'E5T#: 1903314-d 07687 -A <br /> TE DRV 1NTL RUN# <br /> I:Fx�riitY dnfrrnz�tvrr (A al pi'ysti_al Iunrition affaciliej� <br /> Veck crnrz: \ArK L . VROV.X GE'l RATOR C DELBIP,RY Tra AN$?SLD USE.EACII.I'CY <br /> am'inahle: �dr�ot7 Larport Imp/Exp L,rtc�itioat- <br /> ft tbtE: <br /> GOLDEN/STC ACCT#: , <br /> �� � TO <br /> ADDRESS: 7;; 4 TLRE MOGRI,.IA ID: <br /> CITY,ST' <br /> ZIP: 5 SITE SUFFIX: d� <br /> PHONE: ��� � <br /> ,CT I TRAft ER#; A U DEL <br /> rLIUSED <br /> ad Information TYPE CO RATE DOLLAR <br /> IRES PassertgsrE WASTE T1RFS Truck 77 <br /> Intended Use: <br /> 4-WHOLE TTHtE COUNT(C) Tractor C�M�D/ � <br /> �`=—?`rte-- LRECYCLE <br /> rJJ4r,IW,T IN L%S(P) Trailer @ = DISPOSAL <br /> 1-,'� MG,14T IN TANS(T,) TOTAL <br /> I certify IM under penalty of Policy under the laws of a Sesta of California Mai the information Provided above Is true and oonect- adcss t a ware felrift2bw 01814 rbn <br /> Penalllee up b$25,006 pee day,Per vldadw or admen penahVes uP b$5,oco per violation Par day lie descrlby d In Public arca o cite 82 Irdarrrts Moy result Ir <br /> NA�1: <br /> q Regfraxstativc s'r�ame(4 rnr.) act ity eaentMiat s Si r_ leo <br /> ?_�rtt 3: 'c'rxiuer I�urrnaticn, - <br /> TRUCK#: �� /STATE: CA <br /> NAME:'iA Golcteu By-Products, lnc. -- T <br /> LADFLESS: <br /> �3: 2.D-Hex't LIC YTL ATE#:130M Newpori RomST,ZIp: Ballica,CA 95303DECAL#:E (209)668-4855 r' <br /> HAULER EXEMPTION: DGo O AG LLEA EXEMPT LCOMMONCARRIER I]UNREGISTERED HAULEI <br /> DRIVER S LIC#: <br /> fcmot�u'mi un1W]a'rngAty ta'pegf,ry r+natrVa,-Jeuva of 3ttlttr of�,Mtrrr-rte Riot dh�ihYprrrrelfirt <br /> pe neion,revontbn,or denW e1 renewal of the Vvasia T' Hauler RB tratbn Prvvfdec abenra fs tlLo rrra'evrraet-Ai lrixr,t arraraenv"Mt%*ff wft:n of ASdr�trhrtneAtan mq-roetnlr Are <br /> b nmion.r vOcu up,ro rdeniw of r t ase pursuant to Public Reeourres Code section 62960 a y reeuil I I Peneltlaa up to M,M Par rley,par vlofeuon or <br /> Per q o Putin°Reeetaces Lade rgC:,j n X3992, c <br /> UrlyerrB Nemt(Prmt) <br /> Dover's 5i Date <br /> or g- <br /> Tart 4: CJltier lu fo oa"Golden -Products in-house use only) <br /> Jr3G*A. Vi�.GHT err RT#. _ _ _ _ _ �iET W r, TOMS � <br /> LFor the other half of this tramacti ,hauler is also tbe: CGenerator UEnd use facility <br /> .1 Golden's other half of traavection# ' -10t MT H limner EDT Munifcs:;* paper Manifast#in place of Golden EDT Mari# for: (circle one) Field Delivery <br /> So.0 DQtq Confidentiality CJslm(.7ppllAble to all Panles listed on above):The information provided In Part 1,Part if and Pert III of this form should be considered tion <br /> *MW,�PMR'int ",end/nv listen',4r aocmtryrnca viA4 r eYtk 14,GL}F, Spotk r fr�?41 ar.c <br /> nformation, request that CI MB mnlact me tit the address and telephone number above, ehoWa ry mea l al fhe graft,f'Kqu9afdib��tyeurs,>t�,fhy <br /> Eloctronle Reportlny to Cl B:Golden 6y-Produds t)as been authortzed by CIWMB to oartic4mits in the Waste and Used Tire ManlFest EDT electronic <br /> reporting pmgrem,On behalf f Lie cLmrumer listed on this tarn.Golden By-PrOdcd6 will eiectronlcaltyTranamlt to CIWMB ail required Irtforrnelion from this <br /> ^.ranlf�ast flim.. <br />