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. .. _ <br /> fi377 270 4 7 5 -- A D' <br /> r, Pick Up ❑ Delivery <br /> Hauler Tire Program ID / Site SuffixFacilitY Telephone Number <br /> f DATE <br /> LU ❑ ole Tire Count Wei p <br /> Wh ❑ <br /> 60 L _ 9ht inLb <br /> s. � ❑ <br /> Volume Cubic Yds. ❑Weight in Tons <br /> 0 <br /> '�+ar%, <br /> Hauler � s , <br /> Hauler Teleptirl (:urn, U Address Same as Hauler <br /> �{. '�• (J' Cf - '' initials <br /> (N/A for I CERTIFY THAT UNDER PENALTY OF PERJURY OF THE -� <br /> Whole Tires) LAWS OF THE STATE OF CALIFORNIA THAT THE <br /> INFORMATION PROVIDED ABOVE IS TRUE AND CORRECT. <br /> N <br />