I'
<br /> CflIR�G1C18 ,; r;am rl>ye siVb�=-r► °>�iur1`
<br /> � XA �uIP� L .`l 2 .3
<br /> rI111'IC MI ( rM I f 111'
<br /> c,ui q 'n(rg11�STRUG"TION$(1YT�1i�B/�O QP PART 2, DO-NOT pE SLTARLE OR fpUP.LICATIr. t' i L' fti( e?st. +.,: ';;•< :• .
<br /> ;By:alpnlnh lh140A:Opmp7fM1mlko Tdplopp ang110oelpythp 119nir(q}rlgLa/lihd(ha Informalioiiprorld�d ttrr lilarm ci qde 5onrla:rilluonlltl/nl el plop( nd lndYfeppL,-pecgorJum/wI11fT 1.14Q01118eaUon '
<br /> :9TCdi.eCeeq;NrtnquutGmada,lo�U�caloqu Q(Ihla.ln(o1RleQetl;CIIRIo ate ti✓jnl ocriuggliklfpeil(.LotiN/form wl l4dta�reiY int(iftephanahotnh9i proylOdd'on lNlc torpt.or r�cdpl
<br /> c, It1
<br /> art 1 ► r� � �r S" ,c�4 A Haulot':Addroas Eq LX 1 TIr :C
<br /> � � IN
<br /> 4 r t,; Lk�"t� <':a Aeldrps.Er
<br /> ,t d P , :T. r }',• :,. ',� Y hG1 dip, .-0, :Huri.��h )'r
<br /> a '
<br /> V,r
<br /> 1
<br /> tt
<br /> 1RstRMy,d«a�iuiyolg�Inry:wap:un;WWA'ot(Ir@pla(1.OIf7alll6fiU►)hLt:Ne'IUfo d4Nnq'ak(edomovia;VYwM'iorteaL•.ladlJlolf,INhnv(hienwffnlsllo(ttinc(hts (onnpl(opmAYieii0.4e a' ,P+ y.OrU"I'lllbniwul'M'_
<br /> 14q.N'14a�i11 �I(letndry'p�lklt�Ilrj.Inallq P!t!1¢BlgovfoF+Colt Aadhpl3dkOd0.�rA nikiildl fa.oMlpenhtllus vp(o$2G,Ch0 dy isiYYbla110aaadlntnlaliu.o puna IS,$DN Pe dltdv dflasWbetlMPuWpflgaouccgt.
<br /> 'Ari e: rinfi: Dr ver's`$i nature U. a'..
<br /> •q�+ d - a r- I,r 1 1 r � D
<br /> m5gr
<br /> 'ati•' . . ..,.._ ,. ;,..'.; il gA„��r�'�P5�'. {; �N;yx t,�1�+I��P�'IL'�� � nn
<br /> 2412
<br /> 'PQj� rl -en.oX�K, , T dT-• ,Frvl`x ..
<br /> +a _ _` >, Far�ility'Telephone;Nulnpor
<br /> HauerTireProgramAD ./ •Site.,SllfflX , ='
<br /> w_ s
<br /> I, y' � �.�t,;,�r�'!�;�����������1�•� ' �n!�J,�l� 1�,4���5°1� ,_.• hC1' r2
<br /> 1 'i" n ',��',' ,c, I.��r�!:!;,4 �':1�•I� 1•alr.' t` ��71YT!�•r•�t1•;. .
<br /> as
<br /> 65
<br /> Ue
<br /> Nx;n,l.,/.Ftilr1r11148U`�(.lrr�5�1e
<br /> �
<br /> p"1 Haulc;r Nomir � _ :l rs;,}= � .>z•�=aa ! ,'<z y;'} ( ify,..,trll�:• i< I a \1:}.�78 M
<br /> Is,al 1 " 2r1 q
<br /> r' d•:ra I
<br /> i>ts 4 la
<br /> � '; I k•�� '� a'ttfrrlt�tur Lulal;,l Ctlt
<br /> `^ .I 1 ,... L1.A adroas b-mme bit: Isaalar �.
<br /> I'IE1lIlUrf(•/310 h011n NU1TIb0Y ':�,• ,., I (�1 .,, .:,j nllnls.
<br /> f„I�y� Ic.,s•.,,y�i;?,�;tr3 ; I'�w '='N'yFl{ HT't jl''i`y2 ICERtIFYTHAT.LNCERPEIIALTYOPPERJURy DFTHE
<br /> 9 OF i ,1 i y-'r 11'lt9Y\It rI"�l'?,;ten •�h 1a'sry. �gl��Af�r:.c.y
<br /> i� INFOnAt AT ION PPOY111 e0C0 AUOOF IV r.n67'RUEAAND ICOWICC7,
<br /> 5752412
<br /> "'” I ``�t' §f" k�lJ Q( '4 i(Il��n��} I•. l
<br /> 1 1 Hauler Tire Progt:aml.D. / Sita.Suffi ,fRt*+ Cacility Tele hone,Number
<br /> LL
<br /> �dttf+ta�'r❑� glift
<br /> �,. 1 [:+•r~� ',' '1 IIIF�plr1„f f //Y'Cr+ �,(�•
<br /> Y
<br /> 81MV TOlifa PIS ffIt°I c rr,• I
<br /> pi• Hauler Name' I �� �Z3/ .,�,�y "Eif t
<br /> m !, I Il'
<br /> Floul2�r lolelatianb Nunilior '''': a ►k L I.ddl:eas Aamo au Hadlor
<br /> ••::,a�;3:}1�7 }i,,:, iy.i �1J'�`' '�:tE (CERTIFY THATUtICE((P6NALTYOF PERJURY OF THE
<br /> 40 I -"•.b• 3 i_ •{•,:� ;:' '' ILAWD OFTHE STATE OF�ALIFORNIATNATTNE
<br /> 4/M' V W 5, r:,�;:�,�K �,:'� ,j;s.t.',ss, „,,_JT-.,y� IHFf1RhiATION PRCVIDEO AtlOVI;Id TiIUEMIO CCItRECT.
<br /> i
<br /> r -,^xw - t. :,.iF' ii!'r:N'Y•�!$'t?a".rt+R:'r I:r v } ' , r e O I� Pr r'1E h , 1• J rl ' �! I
<br /> t � .19
<br /> -Mouler T1ra f?rQor-.amAR I ` J1e�t t i>� ¢ry Ta ['f77'>vy`Tetepho,ieiN1`li b; r
<br /> {
<br /> e.' 2i J .P' � :F `'�Y� •� C?
<br /> .•' . ��, � ^rw R►$ ��U�f I( ! } �k��� m - 1 fir•
<br /> ,trr•;,:j
<br /> is
<br /> 1 .7•t".t-.: rr.•.':,, ^:s I ,� �F''h �'1 j .� '1 '�1 'iv t I .IWi+YAG'lr 6fl(MJ't�5�!"'"y��{a1�.:P:.. (.�
<br /> f�oUler
<br /> > ::� . r r_ I, t l,�ft pN«'ro 1,c1aY? �� 1 I fKt>A 14 I f f'w3<Itil `17f1fXt 1 '3
<br /> _ - �..f �,,,., _ 4 .I•.. X1.11 1 '. I ��In '' ri 89 c ��0.
<br /> t 8tS
<br /> - f lrltil@r);R OWN
<br /> I!fl�iri��s sv � � '�Jt�i 4lrg�,nlric+. H iu( t
<br /> 1
<br /> t -- - - �5--e_. tyt 0 .hOERYIdYYtT`IIf10BtiP.NpL7l;OF`3EnJNitYdF�Tjie} ;
<br /> ( 1�1/'� p•/ .^+a. $+ d' r l 4 ,`L5(¢t+s 1 tl elT(p d� hAY�SiA)`T 104ATA OF¢r11.TORt11!}jFtAEYi�(i
<br /> �. �,,.. •T` TI � :y'y}:,,1,3fF ;INf 1 ATIOII ID150ADOVE1pQAU@AND.COg1}8 /F'•\V
<br />
|