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• • • <br /> Program / Site SuffixE <br /> ., 18 3 -- A t Pickup Delivery <br /> Ei !�nui�r tJrn Program Ib ! Sltn Suffix DATE <br /> 101H <br /> Facility Telephon? Plumber <br /> -aaaaao <br /> f IY�u Whole The Count OWeighl In Lbs. <br /> "R (J E] Volume Cubic Yds,[]Weight in TanscA <br /> a T <br /> sT <br /> I CERTIFY THATuuoFn PLIrALTT OF PEPJURV OF THE <br /> (r' <br /> /A b,r <br /> Whole Tire;j IAW^,OF TME.ciT ATE OF CALIFOn PA THAT THE <br /> IIFf AMATION PROVIOEO AnOVF 15 TPIJE A110 CORRECT. <br /> • <br /> • <br /> -')) 718035 -- A Pick Up Deliver n <br /> Uy OODaL�! 3 ►�1-L`1 <br /> s hauler Tire Program ID ! Site Suffix <br /> DATE / / a� Facility Telephone Number <br /> c <br /> uJ K Whole Tire Count —]Weigh in L6 s. <br /> a r— <br /> G 0 O 1 I H � � jd F- � volume Cubic Yds" []Weigh:in Tons i � � � �,n <br /> i s i t J k7 rV Gvc+ 4 <br /> I a <br /> (NIA fo, 1 CERTIFY THAT UNDER PENALTY OF PERJURY OF THE <br /> Whole Tire S) LAWS OF THE STAT-OF CALIFORNIA THAT THE <br /> INFORMATION PPOVIDED ABOVE IS TRUE AND COPRECT. <br /> U Delivery <br /> 1p(]Pick p 3718034Q Number <br /> Facility Telephone Numb <br /> DATE <br /> lu Hauler Tire Program ID / Site Suffix o a GI <br /> a®o�® <br /> oQ O <br /> u r JU G..cr <br /> a <br /> whole Tire Count Weight In Lbs. <br /> i i I �,�, veru; 0 O u 0 �►SA <br /> o r o <br /> I �' J <br /> N <br /> � T }'i3l.ltf:r Initi•Is <br /> ,h CTfi(". 'r"J(,tjr�I[7� r' 1 CERTIFY THAT UNDER pEN"TY OF 9EAJpR'r.oF THE <br /> ±..!- - (N/A.}OF LAWS OF TME STATE OF CAUFORNu THAT THE <br /> '^ 5 Whots Tres) <br /> INPoRKATOH PPO`nDED A80YY IS TRUE AND RE <br />