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AML <br /> 4656901 -- <br /> B EPick Up ❑ Delivery <br /> v Facility Telephone Number <br /> Tire Program ID / Site Suffix DATE <br /> : aoo- a®oaoao <br /> R LU Whole Tire Count Weighti <br /> .n Lbs <br /> 1 Q Lb Volume Cubic Yds. Weight in Tons _a r "Z .Mq <br /> c raider`lame S-t�C�1YI CA <br /> :3,�r�3� <br /> Address Same as Hauler /nkials <br /> Hanuier ielepho. e Nurrber <br /> �� (Nje for I AW OFIFY THAT UNDER PENALTY PERJURY OF THE <br /> Y WhO1O TileS) 11�WS OF THE STATE OF CALIFORNIANITHAT THE <br /> INFORMATION PROVIDED ABOVE IS TRUE AND CORRECT. <br />