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LOCATION �,i F, o <br /> ._,� SCr <br /> "IPID 1003974 <br /> 40sco Road 200 <br /> t rtnorc,CA 9455 _sar,r •�a�t T�� �� LEASE REMIT TO: <br /> (925)447-0972 � L P.O. Box 83328 <br /> Fax(925)456-7794_11//o`I WASTE RECOVERY WEST.INC. Portland,OR 97203 <br /> J9,� _1Hautcr ❑Gc cntor EDF-ndUscFacili 1-877-OLD-TYR1 <br /> Invoice Date— 2 q .p 3f(o p <br /> 7'►, Load Date �Q/ 0 87�_l/� C*{ckup <br /> CustomerName ! f7/�L L �A/v��'� Ph e J-, [}Dctivcry <br /> Site Street Address f '?7 <br /> DRIVER — City-)-- i�' <br /> 1 crrtify that undo nil State_ <br /> !x tris perjury undo rhe Lw:o(thr Starr of California that the information pnnidcd it trot and conch.In addition.I am , <br /> aware that falaihcation o WI-Ow <br /> information may tesuk to m pe nsiun,renxuion,a denial (,,-,l raf tM Waste Tut{laulcr Rc s <br /> X ILbtit Rccourres Cede.<don 42960 and mn-rrsu{t to crv8 pcnalries up m$2i,000 er da <br /> vioBtion per day.deunbcd in Pnhhc Acwurccs P 1'per t'iolauun w adntinuuati.e nal�naon Punuant to <br /> (-ode"non 12962, Pc _ tao up to$5,000 t <br /> TRUCKJ <br /> Haul,EacE_mpdon - orrrt__ <br /> ULER G ❑L.EA <br /> IRLR IGTH TRLR I'$�Q y 0Agnc`rb QCQrnm <br /> LI P TE/ ✓� Q R Et PEA 1NANIEESr! <br /> QECAL 1 LIC SilEif OAIVE H CASH! HgRGE er <br /> S-o622� IMPORT�] IOCA)10N <br /> a <br /> 10A0 ARIQI1Ni /V /EXPORT D CUSTT�0/41Eyp TPI TRIP LOG M <br /> WANTITr DBSC/IDhon ( W -UI <br /> Loao TYPE <br /> C-r-r-P Rate Amount <br /> 3 32 • /let;/01 SS0.. <br /> a. a- <br /> ro <br /> Customer Signaturer <br /> �` Total Amount S � 5 <br /> /�Z !ecrtifr that under penahy of perjury uMrr th<lams of <br /> �d�)_ conal.In a.nn P,f am wart tthha fituticanun of Chir nr 5tato n(Calikrnua that th<infwrtanun prrn idrd at,,,u <br /> `�i9 or admutiauativc pcniltxs up ru SS OOO ' fon11O1n may roiuh rn u'il Pr "U"u to$25,000 *tut and <br /> _-- - per riolaunn per day a dcsctibed N Public PLYmr«3 CrPle.,nevi i2%Sday.per no6dun INVOICE <br /> N /OIC C — 956 g 5 6 <br /> so- d dvg : zl 90-£O-UPC <br />