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YLtA�c nems r ��+• LOCATION TPID 1003974- ,..",_ __ P.O. Box 83328 Nevada 019 __ _e =_ _= __ __ / Portland,OR 97283 4554 S. El Dorado St. Wa WM10003: = a 3. -- Stockton,CA 95206 -° , I 1-877-OLD-TYRE Stockton&Sacramento Area(209)234-0700 WASTE RECOVERY WEST.INC. ❑Hauler Generator nd Use Facility � C'h J ? Pickup Redding Area(530) 275 jj1�1160 1-4 �. Q-1 '� -24 Load Date s,' ., Phone# Delivery Invoice Date ;• , 2� � i 1 �,�( iL.:/ �) 11° ll�• � �a<'=••F 7'"��.i r� - Acct #—__---------- Customer Name , F r -.�: t C fj J State��—ZiII 1 n t IL 7Pz? L City Site Street Address L i I certify that under penalty of perjury under the laws of the State of California that the information provided is true and correct.in addition, nu suuaant to DRIV;�i aware that falsification of this information may result in suspension,revocation,or denial of rene f al of on othe r adtrtinistrativee Tire rpena�lties up to$S,OQO per i Public Resources Code section 42960 and may result N civil penalties up to$25,000 per day,Pe Government ❑LFA violation per day as described in Public Resources Code section 42962. Hauler Exemption 0 Agriculture ❑Common Carrier MANIFEST# CASH/CHAflGE � TRLR#'S DRIVE HEI.PER ST�ME I M. TRIP LOG# LOCATION �U I AL ffi; LIZ STATE IMPORT ❑ 1%7 U PLIITf (�- � i e ' EXPORT ❑ LDTYPE Rate Amount LOADAMOUNT Description C `Y-P UANTITY i; ;- '-) Passenger Tires @ ; U r ' !r Passenger Tires on rim @ > l U. +-_- 1.50 1.50 Manifest Fee L �' I t�� h 7 Total Amount$ Customer Signature �••--"� I I certify that under penalty'f rj under the la o e State 'drnia rha a ation provided a7f4ve is true and coo- INVOICE C rete In addition,I am aware t Sifalcation of thr formation may result in civil penalties up to$25,000 per day,per violation or - administrative penalties up to ,000 per violation per day as described in Public Resources Code section 42962. LOCATION TPID 1003974 ,■,�'., PLEASE REMIT TO: Nevada 019 4554 S. El Dorado St. :::=:g :=r:s, -*at P.O. Box 83,328 Wa WMI00035 Stockton, CA 95206 Portland,OR 97283 Stockton &Sacramento Area(209) 234-0700 WASTE RECOVERY WEST. INC. 1-877-OLD-TYRE Redding Area (530) 275-1160 ElHauler El Generator QEnd Use Facility Invoice Date Load Date Phone# ©'Pickup 0-Delivery Customer Name Acct#----------_-----—______ Site Street Address = City State Zip__________ DRIVER I certify that under penalty of perjury under the laws of the State of California that the information provided is true and correct.In addition,I am aware that falsification of this information may result in suspension,revocation,or denial of renewal of the Waste Tire Hauler Registration pursuant to Public Resources Code section 42960 and may result in civil penalties up to$25,000 per day,per violation or administrative penalties up to$5,000 per X -------------------- violation per day as described in Public Resources Code section 42962. Hauler Exemption []Government ❑LEA ❑Agriculture ❑Common Carrier TRUCK# HAULER TIER LITH TRIER#'S DRIVER/HELPER MANIFEST# CASH/CHARGE LIC PLATE# DECAL# LIC STATE IMPORT LOCATION CUSTOMER TPID#: TRIP LOG# EXPORT _ LOADAMOUNT Description LOAD TYPE Rate Amount QUANTITY C-T-Y-P Passenger Tires @ Passenger Tires on rim @ 1 Manifest Fee 1.50 1.50 Ji Customer SignatureTotal Amount$ - I +"°o`°%E I certify that under penalty of perjZy"underthe laws of the State of California that the information provided above is true and tor- r ; rect.In addition,I am aware that falsStanon of this information may result in civil penalties up to$25,000 per day,per violation or administrative penalties up to$5,000 per violation per day as described in Public Resources Code section 42962. INVOICE C _