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a �} -- ► LPick Up De very I�1 ��& Ld <br /> DATE cFoclllty Telephone tVumber <br /> Ll <br /> N:�u)eThe F*ro.rarn ID / $It0SUftlx 11u a" <br /> 1'�� © ) lu <br /> ww Whore Tire Count I I Wel}�ht In Lbs. <br /> { .�. <br /> C Cl,blr Yds. Wolght In no <br /> '�4V o! 711) <br /> � FRJiIRY r�G iNE <br /> cc <br /> nnFv n <br /> rnT nrmrn,cr.n Lrr or P <br /> IN JA for �.Hy of iNE STATE of CAUFrJR 1114 THAT THE <br /> t �♦{ Whmn TRa•) RlFomannu rnovroen ARnvE�s TRUE Arm coRREcr. <br /> I <br /> 0 � oDelivery � � � � � a � <br /> 'PiCk Up umber <br /> 3718041 Facility Telephone N <br /> 10 M 11 , o0EEE—E3E2E0E;,Hauler Tire Program ID ! Site Suftix DATE E�-' <br /> ❑Weight in Lbs. <br /> o a Whole Tire Count 0 7(C <br /> ❑Weight In TonsVolume Cubic Yds, <br /> 2 S <br /> Q 5+V(,le -Crm <br /> .. r IRY11115 �..� <br /> r <br /> K r YI CEPTIFY THAT UNUEP PEMALT`l OF PERJURY OF THET— <br /> (N Il\for u�yg OF THE STATE OF CALIFORNIA THAT THE <br /> Whole Tiros) INFORMATION PROYMEO ABOVE Is TRUE ANn—"ECT. <br /> - n <br /> __ Lip Detl�,ely o ® oaao ®-0 <br /> 3? <br /> 040 I. le one <br /> Number <br /> ._ Facility Te p <br /> a <br /> Hauler Tire Program ID / site Suffix .I. 15 ! D a <br /> :c + Age � � f3g,r �tR tn,l reO u ' n <br /> IT <br /> tegs 5anle aS aulc-; Ing .h <br /> U .i.�.,�..-I '�"` I CLeTtPr rKAT UNM PENALTY OF <br /> pL0.tURY or THE <br /> : . <br /> (ttlAlary- SYATF of CALrA nuT nIL <br /> LAVA OF THL <br /> ... t1QNTli9i7� yA1x1N PR 1 D ABOY[ TAOL ANO COA `. <br /> r <br />