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- ::_ :::-_:::;_::; <br />-- _. _ <br />:.\L:-, }: �S . viz23.''�'�'�'�{ta:'•ti4',iiv.4,..b:.3 .. .. ..-._ <br />SCRAP <br />GOLDEN BYP-PRBOX C 13000 NEWPORT RDE COMPANY <br />O <br />BALLICO, CA 95303 (209) 668-4855 <br />EDT TRIP LOG #: 1003314- 07/3_ 1/2013 <br />DATE DRNERB INR RUN: <br />SHIP TO: • ACCT M. 11GZST <br />STOCKTON WHEEL <br />648 W. FREMONT ST <br />STOCKTON, CA 95205 <br />EDT MANIFEST#: 1003314 - <br />BILL TO: TERMS: <br />STOCKTON WHEEL <br />648 W. FREMONT ST <br />STOCKTON, CA 95205 <br />TPID # 1670776-01 <br />PHONE: (209 <br />PHONE (209) 464-7771 <br />�-- 13000 NEWPORT RD. <br />HAULER/SHIP VIA: GOLDEN BY-PRODUCTS <br />INVOICE <br />00090259 <br />NETO <br />BALLICO STATE CA <br />G LIC PLATE O: DECAL #_ <br />TRUCK #: [] UNREGISTERED HAULER <br />[:]HAULER EXEMPTION: [] GOVTLFA EXEMPT COMMON CARRIER <br />SPECIAL INSTRUCTIONS: <br />E= - <br />U DEL CORRECTION FOR TIRES DELIVERED IN 2012 <br />TRAILER: <br />I uhe I UNIT PRICE_ t EXTEN <br />YPt <br />TIRES W/RIMS DEL 2-10-12 INV#80364 <br />200.0000 EA <br />USED <br />USED TIRES W/RIMS DEL 5-1-12 INV#81702 <br />250.0000 EA <br />TIRES W/RIMS DEL 7-25-12 INV#82591 <br />73 0000 EA <br />USED <br />DEL 11-14-12 INV#84792 <br />185.0000 EA <br />USED TIRES W/RIMS <br />PLEASE PAY FROM THIS INVOICE - NO OTHER INVOICES WILL BE SENTI <br />Invoices over 30 days are subject to a late fee of 1 1Y2% per <br />month, TOTAL <br />which is 18% annually, or a minimum of $1.00 per month. <br />under the lewa of the Stele of Celdomia that the information provided shove is Itue end corte0. In adddion, 1 am aware Nal falsif�Hon of this inlumalbn <br />1 cmafy eve units penalty of p 10 S2 da violation or edminiatnuiva Parelbes up to 56, g Par vbiation per daY as tlesaioed In Puu4c Resources Coda section 42962 <br />my revue in civil penalties up l0 525,OW per Y• per <br />XDate <br />Facility Representative's Signature <br />Facility Representative's Name (Print) <br />E]CHARGE E] PAID CK# <br />WEIGHT CERT <br />NET WT TONS <br />_ re e in cWil Perall'ws up to <br />I coney that under penally of perjury oder ere laws of the <br />Seale al Calaamie that the information prwidetl above u Wa a d m I;W,1110r. I em ere al ralsdicaeon 9i pr— s 42960 mayionrevocall , or denial of renewal of lMWasie Ira Hauler Re dseatlo�HIbaa lO tic Res Coda ee42962. �•'r\� _ <br />talion I stmt ties ui P�° gam; Per �olalion per ay ea _XXP� ( J <br />525,1%1° YlPer via ni <br />or n/C i Driver's ig ature Date <br />Confidentiality Claim (aPPlipVia to all pg. Des listed on above): The Information provided in Part1, Pari 11, and Part III of this torte should di considered <br />�c D°eo Confidemice tial, proprietary, andlor trade secret In accordance with TNe 14, CCR, Section 17041 etseq, should any member of the public request disclosure <br />'off of this information, I request that CIWMB contact me at the address and tel <br />number above. <br />w : EI@Ctronlc Reporting t0 CIWMB: Golden By-Pmducls has been authorized by CIWMB to Participate in the Waste and U6ed Tire Manifest EDT <br />E c tror reponlpo program. I behalf of the customer listed on this tone, Golden By -Products will electronically transmit to CIWMB all required <br />nlC <br />Information from this manifest form, <br />Original - Office Copy <br />