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NOV/17/2015/TUE 09: 51 AM JSG Tzucking FAX No, 209-36 —0879 P, 005 <br /> q. <br /> 5201221 -- = pM,4 _ <br /> � a; <br /> Hauler Tire Progiram ID /.: Site Suffix Facility,Telephor�a Number'f <br /> c: <br /> t ash <br /> Hauler Name :..a.: b'.,.• .,::,u• ,:,; � al� <br /> ° :'�. rte. .. :,: �A; •'„� -.�1',Gh!?ti�t;D, ,rh1;% , <br /> �. �' ..:. :''.• ••.; �1•Iia a�... : .� <br /> tv 1�:, gin .-f CCA �l� zf <br /> Hauler Telephone Number Address Same as Ha <br /> 7tJ� "(NYA{or. ICERTIFY THATUNDFRKWALTYOFPERruRY <br /> IQ I ...dp <br /> ...r .`:>' •''i LAWS OPTHC STATE OF CALIFORNIA THAT THE <br /> +'4VhnTUeB} <br /> —. y.— _... .�.__.._ --�'=..',ai�•R-,yr+.'iy.... - �-.... ._...�, INFORMATION PRO60VE I <br /> VFDED AS TitUE ANO CORIi[GZ <br /> 'lO3iftlOO OMf 311LI1613AO8tl O801AOHd NO11VWlIQ�NI <br /> n11/ �//� S <br /> d1LLlYHlMNtlOdTltlJd031tl1$3Hld0HMV'I (BA�I1AlOtir.1 WI 4"./I/” <br /> 3WdOr nn9d JO AXIVN9d 203W 1YHL Adll Bo I <br /> -11e`x'01 jalne;j se awes sseappv 0 rr aagwnN auoLldela,;`.IalneH <br /> co <br /> On <br /> owe <br /> _1011f lei <br /> T,,.;1 xjUng a3IS / 'QI:we�go�d and aalneH <br /> .:�a uun 'auo da a roe c s, .. � <br /> T. <br /> n11aaf1'uloid 6 T Z T 0 Z 5 <br /> • a . • . Mill• <br /> /� a <br /> •� <br /> 5201203 �- A Pick Up Delivery'' <br /> a 1n I <br /> Facility Telephone Number,r <br /> Hauler Tire Program ID;'./ Site Suffix R*9 <br /> P <br /> vi <br /> •'i r:• L1 r •• �' • �S. t r "\•�i�/l•• .{t( 1h'I.).`}/ ;J f)4,'�`.:� <br /> '..JJl�',7� La :I • �I )�•., e ,: „ ,.\, +' '. ' �;O'.l�Y 'l' u,�y, )1! �• J L/ •Y\ <br /> die")L4, <br /> Q� ,t «:.f'l':.!-'�'.}:FI:jie,=^ �"waa.;el C••'f•` �'l +V' <br /> i:;(:.,' , �l.tJ:)2i <br /> Hauler Name }•ti; }, „'Al. <br /> Addresss Same as Hauler <br /> It hauls <br /> HBLIIerTelephone NumberICERTIF'fTHAT UNDER PENALTY OFpf,RJIJRYOFTHE <br /> ,' fOF' LAYS OF, CALIFORNIA <br /> THE STATE OF CALIFORTHAT THE <br /> 707 �7�� °:Wnoi�tlrQe} <br /> INFORMATION PRovIOEO ABOVE Is TRUE AND CORRECT. <br /> Received Tlme Nov, 17. 2015 10: 08AM No, 1421 <br />