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NOV/17/2015/TUE 09: 52 AM JSG T-licking FAX No, 209-36Q-0879 P, 008 <br /> Comprehensivere <br /> .. <br /> Number Load Information Facility Tire Program ID Site Suffix <br /> 4 � RR <br /> Y <br /> 5 2 0 0 5 3 3 �- F�ICk Ups [7�every <br /> Hauler Tire Progralti ID / Slt�Suffix d; t � FaCIIIty Telephone Number, <br /> oJ'� <br /> 4 <br /> a <br /> coo _ ;• I 0� � ,,I��.�rle Cy�Gnt�❑1Netgh�u�t���, +, <br /> oHauler Name <br /> Hauler Telephnne Number /� I ■ Address Same a; HF l !n IRI <br /> JURY <br /> /(/ —�— _--•---------� (N/Afar ) LAWS F�'TESTATUNDER <br /> OFCAU ORNIAY OF THATTHE ..�E <br /> UC � Whole Ti'ae. LAWS OF THE STATE OF CALIFORNIA THAT THE <br /> INFORMATION PROVIDED ABOVE IS TRUE AND CORRECT. <br /> Tl <br /> 70'[nPreh,ensivqTei'p Log-Nuimber Load*Informatioa Facilft�Tire Program ID Site Suffix <br /> 5200524 -- B Pick.Up Delivery <br /> Z <br /> 9 Fapility,Telephone Number,r <br /> • Suffix ad�r� .., %` ••.� '. - <br /> � Hauler Tire Pro ram ID. / Site a gg 1 , <br /> iu <br /> wo � aoa � o � a <br /> Wholgir�C6dnf a�W�Igh�in <br /> FF <br /> JL6 0101.sip L rr I' TWO�iolurne'Qub(c;YHs ❑.:Weight;i�_To�$ ��.0 C .\1n`1 <br /> Hauler Blame <br /> 0- <br /> auler Telephone Number ■ Addrass Same as Hai <br /> O r� ��r�C' � V /� - Who <br /> to fire' (CERTIFY 14E STADE OF <br /> ITY OF FORNIA THAT TURY HE �_.�e <br /> 1 � 7vC 11e /V/ � � ��'HhOIB TiF6o) (-AWS OFTNE STATE OF CALIFORNIA THAT T(IE <br /> --__—__,__—____.___ IN FORMATION PROVIOCO A80VE IS LR(LF AND CORRECT. <br /> CompreMnsive Tir p Log Num. b. e'r Load I'M r 11 Facility Tire Program ID Site Sufiix. <br /> s, <br /> 5200525 -- Pick Up ❑ Delivery: a LJ LTJ N ® ©- <br /> racility.Telephone Number.: <br /> Hauler Tire Program IA / Site Suffix <br /> a DATE <br /> N �,� �,r LLLTTTIIIJr t <br /> wr to Ttna caunr Iwel n I ubS. <br /> B no R- oa � � oa <br /> I -U c11C�i�t1, <br /> a r 'air�VC11u�me rb <br /> 'u � <br /> 'T <br /> aHauler Name J ;, r[I ytq' r , l ©�. .'�' it y >.,�:� , <br /> Fn g: , <br /> d <br /> Hauler Telephone Number Address ame as auler <br /> '(NlAfar I CERTIFY THAT UNDER PENALTY OF PERJURY OF TH <br /> WholeTlrea) LAWS <br /> OFTHE 6YATEOGCAUfORNIATHATTHr• I <br /> INFORMATION DROODED ABOVE IS TRUE AND CORRECT. <br /> y <br /> • ....:aid <br /> Received Time Nov, 17, 2015 10: 08AM No. 1421 <br />