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12/30/2014 01 :50 IFAX isacram @eastbaytire. com Dianne Amaral 1a007/015 <br /> Toll Free 1.866-896-0600 /www. ac lrecvcleaca-9QY it s <br /> Dept.of Re.aumvi fye np and n... <br /> T.ry <br /> 4—CA Comprehensive Trip Log and Receipts 10002 P.0.eox725%9leramentv,Ca9BB12-1260 <br /> Cam rehensive Tri Number <br /> eftgcle I E I x I AAA P I L I E I1 2 3 - <br /> naj INSTRUCTIONS ON BACK OF PART 2 T I <br /> By tllpniou this CA COmpmhen"1"p Lop and Raaelpt,the Wontlryll r"WEL that the Intarmtllbn proNdap on thl.lorm will I»tlontlkaap oonfldardlal,PreprtHfYy Mp Vada semet.In.owardana vrllh Tlue,14001,4-1,100 <br /> 1709}tll tltlgy N a requaTl N made fOr dbdoWre of thle InfOrtnepOn.OaIR,e,Mb wpl GVMaN tl,e tlIQrW f of Ihla term atTM add,.M Mrd Glrphena rwrrb,r prvvtded w,lhta farm or re"pl. <br /> Hauler Address <br /> Business Name East Bay Tire CompanyAddress <br /> � <br /> On,State and Zip 2200 Huntington Dr <br /> J o Common I Fairfield, EA 94533 � <br /> U Carrier L <br /> Ztlry undo piney of yrfu,y under me lave of 1W81814 of California that the InfarmefWrr p,0V9p/d abrnra In true and OW46t,In MWIUon,t am,,,m that fa,atpallpn er Ihla FntonnellaM raft WUh In tlWDtlrelon,ravoullon.of 10111411 of fanawat of <br /> Weate The Haul.,ft/pllhaflon purawnt to Fu01t0 Rtl/0wo11 Cada aeollon 44960 and n,ey,eeue In BIA panaelee up to S215=0 ptlr day.par bW lun ar a4f0IM1I radva psna lea up to 56,000 ptll'WOlatbn pR day as deacrbd Irl publle Fissoumee <br /> Coda cectlon 42964 r <br /> Driver's Name rin Drivers Signature Date <br /> 4847897 -- C l n R [1 .s - l <br /> Hauler Tire Program 10 / Site suffix / Facility Telephone Number <br /> Facilitye�y+sl e <br /> Name/A�f"oV TIM Company <br /> O o 7 city, state"(PWarris Rve,nue <br /> Hauler Name <br /> s f Stamp or -a a to, CA 95838 <br /> Hauler Tele horrr���e Nurt�bar ❑ Address Same-as Hauler <br /> � LAVYcewTIFT HE STADEn CAUFHNALTOF RMATKAfTHR THE <br /> /JL/ 'jaJ' uvYS Of TM[BTATI OP CAUFORI�IA THAT TM[ fir <br /> INFORMATION PROVIDED AEOY[1S TRUC CORRECT. <br /> r e � <br /> 4847897 -w B 5 0 DE E 0-0 <br /> Hauler Tire Plrogram-ID / Site Sufflx Facility Telephone Number <br /> ,T " JO- 0000000 <br /> F Business <br /> ame/Address <br /> t Hauler Nam �° r city, State and zip <br /> Stamp or Label OK ` <br /> Hauler Telephone Number 0 Address Same as Hauler <br /> I GERTIFT THAT UNDER PENALTY OF PlRJURT OF THE <br /> uW 6 0P TN[STAT!OP CAUt'ORNw TftwT TH[ <br /> 1NFORYATON PROVID[O>+. I TRUEAND COI.iEC(. <br /> eIs <br /> 4 <br /> 84789-7 <br /> Hauler Tire Program ID 1 O,.uimIX <br /> s,5�yr�� aI•r'�,:, <br /> ;li��"n.-1, .4'� ,7..,•1' °I!�il. ]fi _.J Mal <br /> ,:, '7•.,: tJrs ,.�.,C., j �i1E�9�Li,.Y� <br /> r i f i .CifFCY, �{� 'IT- <br /> Hauler <br /> ,�t <br /> Hauler l�'Arris , �• �k{e„ A <br /> iILlIlk <br /> :a N,., ;Ff IYtii{1V�lyrt h i' tca ' yf <br /> ,.. � .W fr Z' {?�:� Y4�,r � '"',��^ ,. �', T ra• <br /> b�� ��, lJler <br /> P�, v� ri ootI,H� <br />