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SE REMIT TO <br /> PLEASE <br /> 8332 <br /> A <br /> :. P.O.B 03 <br /> ,."'�` Portland0 DR 972r <br /> 877 TYR <br /> TPII) 1003974 1 <br /> mss" it _> <br /> e" Asr E QVER w INC• �rickuP <br /> LOCATION Delivery <br /> 400L I Vasco Road _ n Bnd Use Facility <br /> ami CA 94551 Hauler IJOctrcrator <br /> l,ivermorc'p972 Phone# <br /> 925)447- r"l(. � � Acct# { <br /> rax(925)456-7794 .1 ..1 Load Date zipgj <br /> Stated-�--� 1 an, <br /> r� addition, <br /> In Date C' d correct In ursuant to <br /> .. 'a <br /> invoice - rov+dcd+s true an stration F 5 000 Per <br /> '_ Clty the information p y`aste Tire <br /> Hauler Rest to 5- <br /> I - califomia that enaIIies up <br /> (}IASiOrner Name = of the State of anon,or darial of reneH'al of the or administrative p IFA <br /> - under the laws r day,peC violation o ent ❑ <br /> of perl°ry ms ens!on,rev'to$25,000 Pe ❑c'nnn Carrier i <br /> chat under penalty result in P enalties up �p,Sriculture <br /> ` ddreSS 1 rectify on of this information may result in civil P 962. hauler Exemption CAS N�GE <br /> # Site Street A aware that falsification 42960 and may tion 42 <br /> desectlon MANIFEST# <br /> d in Public Resources(:ode se <br /> tion <br /> Public Reser d y descr, "TELPER TRIP LOG M <br /> violation P DRiV I _„ ER TPIOC <br /> _ CUSSOM <br /> LGH TRLR 5. -•') LOCATION Amount <br /> X� TvkL� Am <br /> HAULER <br /> IMPORT ❑ OAO TYPE Rate <br /> + TRUCK';,. LIC STATE EXPORT <br /> `I <br /> t_�j <br /> LIG PLATE M Description <br /> �✓ <br /> ` �v <br /> LOAD AMOUNT <br /> QUANTITY ` <br /> �r <br /> Total Af"Ourll <br /> INVOICE <br /> 'tion Pro 25 000 per day,lx:r Violation <br /> `-;.,;; Galifom-ttithat the infnalmes oP to g25' 42962- <br /> in <br /> Slgnatllfesof the State uf- result in civil Pe (;exle section <br /> der h ?"" 'tion may Resource <br /> natty of 11.IU alsif+cation of tits '�a s described to pttbhc <br /> 1 certify that under Fi am aware that 0 r violation per <br /> _ <br /> nalnes uP to 55,0 Pe <br /> w correct.In addition, <br /> ��- or adnunistrative Pe <br />