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i <br /> 1 M , <br /> Toll Fred 1'866-896-0600r''/www]wm-b.c&giDV/Tires/ <br /> - � coin��Fa'146a a Warta manogment Heard <br /> CA Corehensive Tr" Log and Receipts 10002 P,O.BOX 12581 sacren►entu.CA SUl2-1259 <br /> Will COtfY reh'ensive Tri Number <br /> cn ere"T&q INSTRUC IONS ON BACK OF PART 2 DO NOT TAPS• APLI 'OR D PLICATIE <br /> OV stonlnD tnls CA Comprarwnslve Telp Log and Reselpt,the alarm(■)ropw.r OW the informattan provided on this form wai h-'. corlNdsntlal,proprhitary and hada-*--t (n tgoardana•WWt Tive,14 CCR,aeetlon <br /> t Yget st seq.,Its req—t I■mad'ror dlacloeurw of this lXmation,the CIWMB Will eeataet tM slaner(s)of dtia form■t tM Ad&*o And Mtsplloapgl$lmbrr provk Wed on ihis tom", q, , <br /> Hauler Address <br /> Business Name TiR—NORIX. C•. , <br /> 11W �7 �� = V Address 30900 San Anfoluib S>~ <br /> r City, State and Zip Hayward,CA 94544 <br /> Gomrngn•. 10).429:-29 <br /> LLL12LL1- Povier <br /> corm unclar Pa Fahy of penury and r tea laws of t),e State m GalVomm mat the lnfolmaaon provided W <br /> abroro is o and aorroet.I4 add Rion,i tan aurora tut tAleil(cadon of this trtfarrnatlon may rasua.in auap•n•{pn,nvowapn,a d•nlsl of rorovfaf r <br /> waste Tiro Hautsr R.DiatraUon wr ant to P�ollg ResotNoes Coda faction 42W and may leault In rivfµl penalties up to i 2 vlGarWn or.dmintskatiro Psnaltl•e up to{S pm vialMign par dev as deaorawd In Pubpc Raaounppe. <br /> Cods aadaoaA?9g2 , <br /> Ali <br /> river's Ne J E 1 L <br /> Date <br /> ae <br /> _ a � <br /> Hauler Tire Program Ip / Site "1116,Y Telepkonl .Number• <br /> t <br /> Hauler Name CitY1_ St. <br /> µ t11rp or. <br /> Hauler Tele h -17 <br /> on <br /> P Number' a , Micl ass,S <br /> s.lriawler <br /> I CWTIFr THAT,Uism PEMA<.TY OF PERJUIIV OF THE ` <br /> LAWS CF T111 STATE OF CALIFORNIA THAT THE <br /> RMAfl VIDEM,416vir, ORRE T '• <br /> • I VV0 I I rail • • a <br /> WON Ii <br /> Hauler Tire Progr ID / ix ��Ieph�Ine, IWt1ber <br /> f ;N 11. 2@0 <br /> ii1111s1s1 ,1,11{1..1111(�11 <br /> a � � •� •� � �:,..� t - Ia�t�i##1ty'.SiU91s7es�7'e'1�t'�v`�.Lf:4�.�`1'►��^� <br /> Hauler Name 'I JC ► <br /> 'T <br /> Hauler Telephony umber hr;':: '"' *s rraf: El <br /> Address salYle W. <br /> 8a f <br /> S`J i 1t f ( (, 1 QEATiR11•THk7 UNDER►LRALTC OF'P¢IIJIIFIT OF THQ �7 <br /> — i Z• 4 �4T `� LAW8,OF.TAIIIIATATE OF*XUFtffiNG:'111,a,VjWE . <br /> FORMATIO'PIRDWIDED ,18'M ORR <br /> a a se s- •.s • � <br /> a' • <br /> Hauler Tire Prograr i ID / Site Suffix .raoilltx. I6!ephil M Number <br /> . 117.R .-f <br /> RWEPE <br /> �acilit 1 0, -1 <br /> T3 <br /> Natp��t�tiL�1'�'Irtrrt�,-Rr.�. <br /> ,Hauler Name City,State and2in <br /> ti Stamp or label QK. <br /> Hauler Telephone Number n Addro**.Aartrrls s.c ta•s��br <br /> Z0 39Vd dd00 d0 Hd-�-N00 SZL06VZ60Z T5:L0 800Z/0T/0T <br />