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06/25/2013 10:38 2095997651 MOHLER BROS. PAGE 01 <br /> C, S <br /> I -7 <br /> staic of C'91ifornis rkpnrtment of Resources Recycling and Recovery(CalRccycle) <br /> CalRecycic 241(Rov,04110) Application For <br /> A riCultural/CoMmon Carrier Exemption Letter <br /> Res <br /> Ext <br /> fliv6040 earnoW on tthis fgm in ore t obwn a Wis0lra HitRion <br /> 01&Commonchft Vol to tr"Port iiVA 6r �2 <br /> r Tio <br /> APPLICANT.-COMPLETE(TME OR PRINT W IN10!TENS I THROUGH 7.IFA SPEOFC ITEM DOES NOT APDL Y TO YOUR <br /> COMPANY,ENTER IINIA",FOR NOT APPLICABLE.INCOMPLETE OR PHOTOCOPIED FORMS MAYBE REJECTED&RETURNED. <br /> 1, Business Name(s)': Mohler Bros-,Isle, <br /> 2.Name of Business Owner Phil Molder <br /> Phone NumberLnj59!_-31112 bus Sodel 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(013A'a): <br /> 5,Business Facility Address: 25450 S. Mohler Rd <br /> C4: <br /> Rt on _State: CA_ ZjP: 95366 <br /> 6.Mailing address of business(it different than No. 5): <br /> C4: State: ZIP: <br /> 7.1 am applying for(select only one) Agricultural Exemption <br /> ❑ Common Carrier Exemption <br /> I ccltjy under penally of pegay under ,thr 49Ks of r" or at Von proWed heroin is 4vc 8nd cornea: <br /> 0 1 ,� .Ala <br /> Signature of Authorized Agent of Business: v - — W, <br /> Printed Name of Authorized Agent of Business: Phil Mohler` <br /> Title of Authorized Agent, President <br /> Date: 6-24-13 <br /> RETURN COMN FTED FOAM TO: <br /> DeparVnnnt of Resources Recycling and Rummy(CelRecyde) <br /> The Hoular Compliance Section <br /> P.O.Box 4025 <br /> Sacramerdn,CA 95812 <br /> kiwWoo S�bj log <br /> _Md),p"oft iWAM.co 6r.re*"I bf <br /> r,T,il.I i th.: amgon the 4st pitvkli4 iq.. 4rpxttF+ieril or C fol d �wo, land to <br /> f0t W�IDIW tr**by,child V10* ftafe be advism ttw thif ikw ,vcp�rir <br /> .. <br /> rhGftilrrlefJtMrM1,lOfW04L6O 6t, *41 PC"tvi tH%a e6mn iibei,w to* <br /> a <br />