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<br /> CalReccle �.t,' tk ,,,;�
<br /> •1,10910 PL OR'D I ATEk "'�=:°`t'
<br /> c,m,9y�e2'oimfo�INSTRUC'I'IONS ON BACK OP PAi�T 2 DO NOT TAPE.STA E UP.L C ••
<br /> Sysl9nlnp1h11OACamprah.n.ive7FipLogandReo.,pt,th.slpner(e):requ..tthatth.lnformdfonpravldedontNslormwillbeoonddaredaon rdial,proprietaryand[rode o.erel.Ineoocrd.noewlthTl0e,14OCR,Section
<br /> 11704fe1 asq.,If a reque al I•made for dl•oloeurd of Wt Information,CelRaayole will aontaot the$I at of 1411 faint at the address and telephone number provided on 1411 form or reeelpL
<br /> I r , Hauler Address F East Bay Tire Company
<br /> V.<
<br /> Business Name
<br /> Address 2200 Huntington fir
<br /> kL
<br /> ' City State and Zi
<br /> Fairfield, CA 94533 I
<br /> ( .: Common J
<br /> 3r Carrier
<br /> I certify unaer pehalty of pidury under the laws of the 6 of(Call( la thal the Inlormallon reVlded above le true correct.In adds lon,I am aware that faldf -110n or INe 1pformatbn may result In so.penslon,revocation,or denlal of rerl.wal of
<br /> the Waite Tim HoWer Rsp11lratlon pursuant to Pu so es Cod seallon 42900 and m r I In clvp penalties up to 620,000 per day,par v[ofe dmin shallva penUtiss Io 00, par doMlton po day duroryibadl PYb90 R.eourees
<br /> Cad.sown 42902 i
<br /> Driver' ,Name.(print: iDritigr's:S(g n�t�^fre� DaJt�•
<br /> — . • • Program
<br /> • e
<br /> 7Comprehensive • •. • •.
<br /> 56,307-63'
<br /> �r Facility Telephone Number
<br /> ~ Hauler Tire Program ID /, Site Suffixt�
<br /> 1W:: ole Tlrt3 G4Gnt<-,❑ 141 l
<br /> fl ' r+t } 4Cilit Bt1S 0S^
<br /> G�' ,,,,,,. Il`. �61U1[(0°GaYbitsrlilis vJeightm Ton$I
<br /> '• '�sr`. d t3'k:s.',-���d>.;`_:.,•• , _ .;;.'�. ;itatn
<br /> elJ/Ataci•dl.r3b"G� S�$B
<br /> DTire CompCn
<br /> 4
<br /> NFAM
<br /> City,Sods;andOarris Avenuo
<br /> CF195838Haulor Name olC� KPntOr
<br /> Addi-9&'Same as Hauler —
<br /> ,moi (� ❑ Infflals
<br /> Haulerr�7Telhone e
<br /> mI CERTIFYTHAT UNDER PENALTY OF PERJURYOFTHE
<br /> ber
<br /> IHE STATE OF CALIFORNIA THAT THE EDABOVE IO TRUEANDCORRECT-2, NFRIAA1
<br /> _
<br /> fir`
<br /> .n Load 1 • Program ID Site
<br /> Suffix
<br /> �-' 5630760 '- B Rick°Wp
<br /> a �•
<br /> �r Facility Telephone umber
<br /> Hauler Tire Program ID % its Suffix s '
<br /> DA7k�- ooaaa �
<br /> .w,��w 4
<br /> '.. h o Tlr- duh
<br /> Vplu:1 l,di'E❑Weight In Tons' Nlirne Adre 9v;
<br /> t
<br /> ECity, ais cold"'it,
<br /> c'. Hauler Nam i f.r ;.
<br /> ' S''.atYtl)or i.ztt•,iti Oit-
<br /> ;�?' Address Same as Hauler
<br /> Haul Telephone Number t t refs
<br /> '(N/A for: LAW OF THE STATE OF CALIFORNIA THAT THE Of
<br /> Whole 71rP9) INFORMATION PROYIDED ABOVEIOTRUE AND CORRECT.
<br /> d Information ProgramSite Suffi,
<br /> Comprehensive •
<br /> 5�6 3.0.7 6.3 ...
<br /> • •
<br /> g ufflx r FaL�il1 +�`elbphgne Number
<br /> Hauler Tire Program ID / Site 9
<br /> Hauler Neme ? `�1 1 t {
<br /> J ;
<br /> 1
<br /> l cess Same.as HsL tear hraefs
<br /> Hauler TTpilephone Number ? s s (lCERTIpY fHATUHDER PENALTY OF PERJURY OF THE p r
<br /> OF CALIFORNIA THA TH>?
<br /> (1'(f/� �/,JrV(/y G I y�l' h1j •INFORMATIQN P.ROVIOED ABOYEI9 TRUE ANO COR E¢T.
<br /> r _ r - •. a .., 40-
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<br /> 5
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