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06/25/2013 10:38 2055997651 MOFLER BROS. PAGE 01 <br /> State of C'Mifornd a Tkpartment of Rcsources Recycling find Recovery(C-alRecycle) <br /> CalRecycle 241 (Rev.04110) Application For <br /> Aencultural/CoMmon Carrier Exemption Letter <br /> bt. <br /> 06d6 <br /> Public Resoum-&Gode;and gecti:60M,tf Tillef 14,'Co <br /> RUM Waste Tffe otow <br /> ,. this . ', - <br /> ft In ot�4i.tO obtain,a� <br /> used"I"te <br /> APPLICANT.•COMPLETE MT OR PRINT ININK)ITEMS I THROUGH 7.IFA spECirIC fTEU DOES NOT ADPL Y TO YOUR <br /> COMPANY ENTER"NIA,FOR NOT APDL ICABLE INCOMPLETE OR PHOTOCOPIED FORMS MAY BE REJECTED&RETURNED. <br /> 1,Business Name(s)'' Mol-der Bros.,Inc. <br /> 2.Name of Business Owner Phil Mohler <br /> Phone Number (_209 )599 _311.2 bus Social Security Number <br /> 3.Name of Business Operator or Manager(If different than No.2): <br /> Phone Number (_)-- <br /> 4.Other business names that you are using for tire-related businesses(DBA's): <br /> 5.Business Facirity Address. 25450 S.Mohler Rd <br /> City: Ripon State: CA Zip: 95366 <br /> 6.Mailing address of business(if different than No. 5): <br /> City: State: -Zip: - <br /> 7.1 am applying for(select only one) Agricultural Exemption <br /> Common Carrier Exemption <br /> I ccrjify Ltndrr penalty of pe jUly under the 49 ws i)fi1or ' at th,63 aV017 provided herein is truo and cared: <br /> Signature of Authorized Agent of Business: rftv- <br /> Printed Name of Authorized Agent of Business; Phil Mohler <br /> Title of Authorized Agent President <br /> Dake: 6-24-13 <br /> ,V7UPN COWL ETED FORM TO <br /> Department of Resources Recycling and Recovery(CalRecy6p.) <br /> Tire Hauler Compliance Section <br /> P-0.Box 402.5 <br /> Sacramento,CA 95812 <br /> •:J#Sft"j,j"6Wr0Ujqz00 l?r.C5)rLbjMtiH bifity Gwj",=pots;^o"Polftfcal <br /> jkni.Wd <br /> 7w(m 13� Y <br /> -.0,urwintto rMqCw6Si app <br /> ItilMew by the Depiximent,MtC9.prdvW nijhlbe+3 to <br /> ffild <br /> the fig p6yv*'byft.D'epI0­M' rltDfC 3r, <br /> a an ibma". <br /> d b4 v9d, <br /> respond to ftom.ts-W.lhfbft rAde by.0il' sdpfM Agencies. <br /> A,bift <br /> we ffiet IHS. sector,awes W&OOYA�:Ueftd L, <br /> L <br />