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LOCATION TPIr)0'74 '.'�'■� PLF' zE REMIT TO:
<br /> 4554 S. E1 Dorado St. Ncv' - - R( x 83328
<br /> IVa 1Vu\115 = _ tartjand,OR 17283
<br /> Stockton, CA 95206 1= = � t
<br /> Stockton &c Sacramento Area(209) 234-0700 WASTE RECOVERY WEST.INC. 1-877-OLD-TYRE
<br /> Redding:Area (530) 275-1160 PIlauler El Generator D End Use Facility
<br /> Invoice Date ll -- 2 7 — IS Load Date_? 7 ,� Phone# lir4ckuey
<br /> Customer Name._ Acct#
<br /> Site Street Address City 4z�—,a"-:; r ' '"2 State Zip�,2 '_4:
<br /> DRIVER I certify that under penalty of perjury undcr the laws of the State of Caltlhrr»a that the information provided is true and correct.In addition,1 am
<br /> awarc that falsification of chis i r,mumion may result in suspension,revocation,or denial or renewal of the Waste Tire Hauler Registration pursuant ut
<br /> r S25,000 per day,per violation or administrative penalties up to$5,000 per
<br /> X__: ' i '..+ violation per dal'as described in Public Resources C•odc v�crion 42962. .....".`"
<br /> ,. a..__- ._ _ _ -_---
<br /> Public R ources rode section 4296U and may resin[in c•n�il penalties up to Hauler Exemption (�Govrrnntcut
<br /> Agriculture _...jCummvr.Carrier
<br /> TRUCK N HAULER TRLR LOTTRLR#'S--
<br /> DH�VER/HILPER MANIFEST# CASHICRARGE
<br /> I ,
<br /> LIC PLATE b DECAL Y, LIG STATE IMPORT 0 LOCATION CUSTOMER TPIDN: TRIP LOG#
<br /> a t ( EXPORT
<br /> LOAD AMOUNT LOADTYPE
<br /> QUANTITY Description T-Y
<br /> L' P Rate Amount
<br /> ' I -
<br /> Passenger Tires @
<br /> Passenger Tires on rim @
<br /> 1 Manifest Fee 1.50 1.50
<br /> Customer Signature Total Amount S
<br /> "•"', 1 certifV that under penally of erjury under the la cs of the State of C tlili�rr is that the inti rinati n provided aboec is true and cor-
<br /> p rest.iii addition,I am awarc that 1 Usiticatioa ut this Information may result in civil penalties up to$25,0011 per dav,lxr violation itr
<br /> administrative penalties up to S5,00 per violation per day as described in Public Resources Code section 42962. INVOICE C "
<br /> LOCATION TP11-) 1003974 ".�'i. PLEASE REMIT TO:
<br /> 4554 S. EI Dorado St. Vcvadt 0t9 c=7 'Mm"um P.O. liox 53328
<br /> Stockton, CA 95206 Wa�4'♦t t0003a __ -- __
<br /> __ Portland,OR 97283
<br /> Stockton &c Sacramento Arca (209) 234-0700 WASTE RECOVERY WEST.INC. 1-877-01,D-'17YRE
<br /> Redding Area(530) 275-11.60
<br /> 14
<br /> rrp�Tt llauler ❑C,,�ncrator I End Use Tracilin'
<br /> Invoice Date�.�2 Load Date '" r'* Phone#, [ cltvRw`
<br /> Customer Name Acct
<br /> Site Street Street Address City State Zip_
<br /> DRIVER t certify that wider penalry of perjury under the taws ofthe State ofCalnornia that the Intnrmation prtnided is true and correct In a Wninn, •34)
<br /> aware that falsification of this into mtation may result in suspension,revocation,or denial of renewal of rttc Waste-fire 4lauler R'gistr i n pursuant to
<br /> Public Resources 0xic wction 42960 and may result in civil penalties up to$25,000 per day,per violation or administran%c penait:ics up to 55,000 per
<br /> t visdatinn per da, as d1"nbed in Pul:lie Resources Coda ucriun 42962. _6-rr"uncut 1-LA �.
<br /> X— ?_' I V liaulrr�E�cmptirm i ❑
<br /> r,..l.•rtrtculture ❑Common Carncr
<br /> /
<br /> TRUCK P TRLR LGTH+ TRLR N'S D.RIVERIPELPER MANIFEST N CASH/CHARGE
<br /> N! .ULE . ...
<br /> LIC PLATEN DECAL N, LIG STATE,, IMPORT I LOCATION CUSTOMER TPIDN: T51PTO G I,
<br /> '-`✓' �' '•. f' .} rp,,,". .' EXPORT
<br /> LOAD AMOUNT Descri tion LOAD TYPE Rate Amount
<br /> QUANTITY p r.-T-Y-P
<br /> Passenger Tires @
<br /> Passenger Tires on rim @
<br /> 1 Manifest Fee 1.50 1.50
<br /> Customer Signature Total Amount$
<br /> I'cr ,t undcr penalty of rl.crjury undcr the lays of the State of California that the inGurmation provided above is true;m-' f
<br /> IM /'�
<br /> ren :tion,I am a v arc shut f 1',ifi stion to 11u,infimnation may result in civil penalties Up to$25,000 per day,per viola INVOICE C
<br /> stint ave penalties up to$5,000 per violation per dao'm described to Public Resources Code section 42962. 17694
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