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LOCATION 1'i'11) 1003974 '.. ", PLEASE REMIT TO: <br /> 4001 N. Vasco Road I!?a! lana, tau tits P-U. Box 83328 <br /> Livcrmorc,CA 94551 " Portland,OR 97203 <br /> (92c)447-0972 WASTE RECOVERY WEST. INC. 1-877-OL.U-l'YRt; <br /> Fax(92 5)456-77V <br /> Hauler [_]Generator F]End Use Facility G �/� p, <br /> /J; 16- o f ``��� C7 i'gC'O�(177-1 G T9 Pickup <br /> Invoie Date Load Date -- Phone# _ [�'Dclivcry <br /> Custom r Name oort `A Ll._— l.A/q �t I t--L___cerin}{1 O� Df G t Z C)-S:CFS(. <br /> Site Street Address ) W�r �l t �h` City_�. &j �t N State IC p_Zip 23� <br /> DRIVER l t ertA-than under Penahr of pequry undrr thr la y of ti r Sntc of(alt arnia that rbc informatwn PA—adcJ is trac and currm.In a ktitarts,1 am <br /> awue thu W.'ifieation of this infixtnatrm inay rrtuh in anpwn o,),—Xanou,a drn of of raxwal tdthe Haste Tac Hauler Rcgstration rununi m <br /> Public RSY)UrCta(bale.ecriun E27(A atal may r stah w—d Irrnaltr-s up to S2S,000 Pet day ptr nofamm or admutistrative penafnes up to$5,000 pct <br /> vrtalarion prr,fat _ <br /> X-- - as AexribcJ mTubli<Ra ror afadr a:,rinn 42Yt.2 l Laufer L•acmpdan C7Ga trnment OLEA <br /> I lhuirtdttarc (.)CommonCarricr <br /> TRUCK I HAU ER TRLR GTM TRLR/'S E ELPER MANIFEST I CASHACEgW <br /> UC PL0.TEI EGA( u uC Si E IMPORT [� LOCA ON l CUSTOMER^04 TRIP LOG I <br /> 0� V EKPORTU `l1I� <br /> LOAD AMOUNT �e$Crt 11011 LO TYPE <br /> ouARnty P C isl P Rate Amount <br /> 6rJ --to 6&0® 1p 0 <br /> Customer Signature Total Amount$ 1 //67v(5 <br /> T�•�'a" I rw<ry that"Co ty of fequry.mdcr,the law of the titan orC av—ta that Lha utturmation t)S2•;,J 0 Tic, h auc and INVOICE C 1 C„ f <br /> corrc<r.F}t aJd+txan, am aware that lilsi5cation of rho.nf(Kmariun may rna7t ur.rtigl Pcnalucs up to S?5,000 pct day,1xr violation <br /> or adminiurati+•e peraalties uP to SS Ano Ixr,iolauon Per day as JeaenbrJ rn[4rFhe Ra•v,was Carir sea urs X29(.2 <br /> #sO'd dbS = ZT 90-CO-UeP <br />