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12/30/2014 01 :51 IFAX isacramf @eastbaytire. com Dianne Amaral 013/015 <br /> Toll Free 1-866-896-0600 /www.calrecycleaca.g <br /> Dopt,of neaourcee nuoyoling and Recovery <br /> 00 CA Comprehensive Trip Log and Receipts 10002 P.O.Box 1250,s.o.amento,CAOS812-1960 <br /> : Com rehensive Trip Number <br /> A i.l <br /> f <br /> am Je°a'asoirWQUPIIINSTRUCTIONS ON BACK DONQ .SPLEQRCAT� >K 'W` i <br /> �ak �rA0 �M �iomtWmnf°�nartl� ulwuWmiv.bl.tlan rtia mmL. <br /> tw.lpl pRna.whh Tkl., a OCR,eevn <br /> 1. ��! rd:e- nme � mt. riC wd ee ,af tng -t-0 fM aars aa0numb <br /> Hauler Address r East 130Y Tiro Company � <br /> Business Mame <br /> Address 2200 Huntington Dr <br /> City,State and Zip <br /> Fairfield, CA 94533 <br /> s Common _J <br /> s. Carrier <br /> I oartlf uundo.pi txy Of ParJury under the MWe Of Mi t31Rle v}OellbfnN the'the Infametlon provided Ways Is true and wmtt,In oddldon,I em&wale Ihel ralYflw an of IIIII,tntp„nadnn mayroeux In eul0enelen.nv jw on,or dtnlal at mnewsl of <br /> fie Waate The Hauler Re9lrlra0en 1)"jard 10 Pwilt R91gardee OWI,eedl:a a29H0 end may reaull m:I W prmlNu up to 9 70,000 per day,Per violation or edRflnkuadva penartl..vp to$5,000 Per vlaleUan per tlay so <br /> oeocrlb.d In Puellc Raaduroae <br /> �tle aterll 904 �MW <br /> /0Name Driver's SI nature Date <br /> e <br /> • <br /> ------------------------------------ <br /> aE <br /> 1 V O Y-ee"iffe'sessee <br /> 1 <br /> Hauler Tire Program ID J 31te'SUffix <br /> .Facility Telephone Number <br /> a as <br /> &ESly Tire.Compony <br /> r, I3rtrriel+�dtirc��8 Hf�rrf5'f�vettue <br /> C _ <br /> Hauler Name Sacramento, CA 95836 <br /> ,/rEl <br /> Hauler Telephone N er //f� ;.� F,: ^A! Address,3arrle as fiau�� <br /> Jy/[ne r4�,I ` •`'f,,`;S' ,,._•:,, (f, }:. .'� ICERTIFY THAT UNDER PENALTY ofPERJURY 0rTHE <br /> 1 -rv! / `(j ,''1'••, !.%�'ha`'.•" »(51��,!y''Y�r 4a 0�o•'i� LPW60p THE STAl1'OF CAUPORNW THAT TME 6l^ <br /> T- I10014MATION PROVIDED AS OV9 th TRUE NoORREC. <br /> e <br /> 4 6 <br /> /j (� <br /> .6i Y ila�2r; S1 rRfl' a 4' I r' IL {7 tnly 7i ri q.: � <br /> . .., � �. •d..):I'9;r.p.rll'J.i: 1'. 11ffi�ITtiA�n nls• - " <br /> attler Name <br /> Q.. alll.tr s lwf 11 iar,v� �r;.,❑ Ir;;r. r <br /> ,I ' :•n:D Py .11 <br /> sfE1 fg, ,��j: Y'� 3e1'C�K <br /> -•= r.' , t" l X:'S ifix,: IF!t9, 9�{c. i+Jl6l7 <br /> Hauler Tel p no Number rv' Fi �[ Pb, g;haulerIRIMAIN <br /> ',tStlii;fh G YH�6YAYEAd 0, ERJIURYO <br /> omk YHA"TH[pTHE <br /> 1 <br /> ti <br /> 4661,000 -- <br /> Hauler Tire Program ID /'.Sti�e�iufx ax r <br /> :+'f:-,r�'•tr!: ,rt�i'Y:it[T}$ili 13 tCI: _?0 �:nlU'![ I <br /> =rW, <br /> Hauler MM4" <br /> ,- r.•I cl+� +�., t �,1111.1r v.A-'"•4 •�'�� �4EJ�V1; "�( h1�3�r� Y�12 p[ `'�~ :1 4 :� IJS1• I •. x,�.•)•� '. <br /> fp A•� ".'�?t•t.+rv:Kp,t ,d6,{rinr.nlri tut"n.+ <br />