Laserfiche WebLink
r <br /> I <br /> CA Comprehensive T <br /> rl L.og and Receipts CillfOrnie lntogr4led waits Management 61 <br /> C,x P.O.Box 1258,SaWSMonto,CA 86A72—1 <br /> ��' E� k 2 S =• Com rehensive Tri Num <br /> Y4bYr sfnf. INSTRUCTIONS ON BACK OF PART 2 D NO TAPE, STAPLE <br /> `'.� <br /> cd+'Ndny�rablr 'DU ,if.,.ay ' 57 <br /> by f110n1 y I'll,GA Con,ynMnslrY 7.1p Loyy,d gaw�pL py alpn4(Y)ngaaal lnr,U,a Infa-urf ICA <br /> 1 W f Ol�eYq.H y n)eYp t 4 maoo! dl{e1WYru e11Ma Inlpmdlbn dW LlWylg MII een001 pW "ot "d p�Nlp f-.oqI Ow C61--Ide ee Gunlly njW.Y•e•f1e{yy,wJ q�Iven4 In Oefa <br /> •Ignrarldl�7 u.4 iam w u,e•yQrou as eeiGob.,rr n,rnnnf,."• •dw,w wlu TIG,14 CCR. <br /> Secth <br /> %til-T,,. � Ip1YUpr1( urilfQ a,Yar wm14f nCf♦Ipc <br /> Hauler-Address <br /> w I y r <br /> z '�\�/.✓ 1.... r,y;+ilCLrSs'a5 .,tyE. <br /> Business Name <br /> Addressl 'j' '��' l�"y �' - '•i . <br /> f , <br /> Cit <br /> Y" State and zip �r,> <br /> 1 Cm tl/y rroo u vly 0p1'IMnf / OW Ir a In4'E'01 InY Blele Or CONo s Inde Yb I•NgrinOaeu '• - - <br /> C..IY TIr4 NOYIuf R 4.0 'jpwwwf to pyyxd%W'o.t;" OU6 W�Wntl inu�u b VYa CMI uXn xt 4,�ldtlbnI:w".rwp0'111it/N IyGa1101f f the�ntpfnlYNvii <br /> Cu.lu eedlan n„yj"9, <br /> S s!�etion a(2.!19p dna nwy rdeul,in else py,wlllds �.�0 n+aY rdeWt 4r <br /> 1~ ,'' ti,. -f /K..�7. :-1 ` •,'�r ve'aaV,Otw Wil•ua,a�arflnNt»t{vd yanedws up to j.1.000rrroude.�.tX ea,LJ or r <br /> am(go Jqay'i x do.IxJbaa In Atibl; . <br /> Faf vblawan <br /> s Name.(prinf �- at - <br /> �' Date <br /> 302715 <br /> 11 F1 n <br /> Hauler Tire Program ID / Sits Suffi rt �� ' <br /> X3Js1Fti . Facility Telephone Number <br /> IF <br /> i rwsl ✓ y �U <br /> �ciNty' <br /> f Business <br /> t <br /> Name/Address <br /> Hauler Telephone y. State and Zip <br /> P Number ..Cit <br /> Stamp.or L•abol OK <br /> n. a ���p�¢•'yl'�'f 4 'y'/ ,I: = 1 CER71PY THAT VHOER PENALTY OF PENJYRY OF THE <br /> r uwe OF THE STATC OF CALIFORNIA THAI,rHE <br /> �7GC•' + e I . , �! levo NATION v YgEU AnOVE b Y +E AND RECT. <br /> 3027157 -- <br /> Hauler Tire Program 1D / Site.Suffix '"':`'r�''s'�� ' ,r”�•. 4+:1;: <br /> Facility Telephone Number <br /> ,J <br /> Fac7�l*ity Bu iness <br /> N; <br /> .�� 1 <br /> l Hauler Telephone Number ! '' �� ell tate <br /> Stamp or L�a'bet�OiC ' <br /> 7l,F Sy} .,•r i kJr_ylffµt Y 0• „�v Y°, IGEI2TIFY'I HAT u"0M PSMLrY OF Pf*JUAy of lIfE YIIUdIs <br /> �.; ,. w-, si_-.1.}Wi!' ,Y�iFYY'0:•Y •,\—j }` <br /> LAWS OF 1HE 3TAfE OF CALIM)RNIA THAT THE <br /> - _ {iY 4li` HFpRYAy p PR.Ov10EOAdav TR •.qyD C:6DA Cr. <br /> { 3027157 <br /> Hauler Tire Program ID if Site SuHrxa,': + �, Facil ty Telephone Number <br /> . <br /> F ,1 f•,pt <br /> Hauler Telephone Number r- ! City, Ste and Z1p. <br /> r f I r <br /> Stamp yr Labet OK <br /> •' vii. ..... `� �'; ... <br /> ZO 39bd 9998E8660CT bO:LT L00Z/8Z/Z0 <br />