Laserfiche WebLink
5�0 4 9 A [ZPick Up Delivery0 N N <br /> _ <br /> J <br /> 4) Hauler Tire Program ID / Site Suffix / <br /> DATE Facility Telephone Number <br /> u-J <br /> } ❑ Whole Tire Count ❑ Weight in Lbs. _ <br /> 48083 5 - 01 _1 <br /> �Jolume Cubic Yds. ❑ Weight in Tons I 1 " <br /> V < ` <br /> o -auger Name _ <br /> Tri-C MFG/Tire Recycling Div -`��, '� <br /> r �' <br /> a000fl'� Ono <br /> G <br /> eleptr_,:_ Number �� rrJ <br /> -�&A�idres j5ase as I�iauler <br /> 916-371-1700 (N/A for I CERTIFY THAT UNDER PENALTY OF PERJURY OF THE tnitia s <br /> Whole Tires) LAWS OF THE STATE OF CALIFORNIA THAT THE <br /> INFORMATION PROVIDED ABOVE IS TRUE AND CORRECT. <br /> -: anal?y of perjury undEthe laws of the State of California that the information provweu <br /> -er Registration pu uant to Puohc Resources Code section 42960 and may result in civil penalties up to$25,000 per day,per vioiauun� <br /> Driver's Name (print) D ver's Signature <br /> Q 5 6 7 214 7 -- C Pick Up Delivery <br /> 0 <br /> U <br /> >z Hauler Tire Program ID / Site Suffix Facility Telephone Numb <br /> DATE , <br /> M a ❑ Whole Tire Count ❑ Weight in Lbs. <br /> a.. ❑ Volume Cubic Yds. ❑ Weight in Tons Name/Address <br /> -raider Name I-1I-1(-1 "=ty, State and dip <br /> hn n n <br />