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2011-10-19 14:51 Golden oducts 209+66�O�Z "N>WcM IIOZ '6I '�06' 7u Ci P;A1 3 <br /> VV'LUCN t$T-rKuu ".I5 dda SCRAP TIRE COIIAPA <br /> P.O. BOX 1 / 13000 NEWPORT RD. INVOICE <br /> SALLICO, CA 95303 (209) 668-.4855 <br /> EDT TRIP LOG#: 1003314 05/08/2011 AM 1 EDT MANIFEST#: 1003314• 00076630 <br /> DATE DRIVERS INR RUNS. <br /> SHIP TO: ACCT#: EVER BILL TO: TERMS, NET30 <br /> GIANT TOYOTA TOWN EVERGREEN OIL, INC, <br /> TOT001 2415 CAMPUS DR. STE 225 <br /> 2150 E HAMMER LANE IRVINE,CA 92612 <br /> STOCKTON, CA 95210 <br /> TPID# 1028679.01 <br /> PHONE: 0- PHONE; (610)608-0159 <br /> HAULER/SHIP VIA: GOLDEN BY-PRODUCTS 13000 NEWPORT RD, BALLICO STATE CA <br /> TRUCK#: 135P067 LIC PLATE#: 8A41698 DS L : 11-04378 <br /> HAULER EXEMPTION: GOVT I I LEA EXEMPT �COMMON CARRIER �UNREGiSTERED HAULER <br /> SPECIAL INSTRUCTIONS: <br /> TRAILER: PU DEL Po- aS ( t% <br /> TYPE COUNT U/M UNIT PRICE EXTENDED AMOUNT <br /> PASSE G T EA <br /> PLEASI;PAY FROM THIS INVOICE.NO OTHER INVOICES WILL BE SENT! <br /> I11V01CeS over 30 days are subject to a late fee of 1 1/2%per month, <br /> which is 18%annuaay,or a minimum of$1,00 per month, q TOTAL <br /> I unity that undor b orpwpPy Vnda u,a d u,e f fain o/Catlfoml0lnot rre irdarmeaon prevlped Ot10V0�trv.aM evrtxl In oeoWon,I am amore irtel fa{:aiemrorf o7 hie Infonrwuon <br /> may loewl In a [Lies W to S4L, r dw.ow Vlolallm or ad6Nnla adi.n nluoa UP 10 50.000 Par Aalm;eA pet e4y as OaWbod in P�e Ra,ourom C@da wnt6n Aeoe_. <br /> FwUI ooroao v ' (Drinta Paeul�ROproopnredva'a 6t9noluro odic <br /> 2'CHARGEPAJD CK# <br /> WEIGHTCERT S7 ODD NET WT TON5 <br /> t mor*lhm,ndw pendiy d PoOurY undo aro Inre d Iro Slow IN Caularnie oaf O,o Whr,bmn provWoO o�.o- 0 corm n oddifie t am&,We oux fal-5b iw or we Inlorrrallan <br /> mar rwu4 Is,wso.no:-.ruwCatipn,ur Jurwf orrenowW of m waslo Tiro ItWaw No017tralwn pweua ft IIRNC Ro coon 42980 and mo Mob up to <br /> izG,000 pet ae1 pp V Olello ror a0minlolre,he per,et iae up la 95,000 por rioM4n Cor dsy as oew4 Pus C •s <br /> Dtl+ror'a Nome(PrL U WIV04's SlgnaW0 dale <br /> Conf(donttallty Claim (appLimble to all pantos listed on above): The wonwftion orovided In Port 1,Port 11,and Part 11101 this farm ahawd be wnalderacl <br /> `Q'c Daror, confldantial,propriowry,orld/or Vada ao=L In aerardonue with Thio 1a,CCR,Section 17041 ol.aeq,5houla any member cr uta pubiil;requw dlzawrc <br /> of tnts Information,I r0quast lhal CIWMS eontact me at tho pddross and talophono number above. <br /> r elo0t/onlc Roporting to cwMe: Golden Dy-Pfndvcls has been twfthzcd by CIWMB to partiolp„te in the watto and Used Tiro MonHest EDT <br /> ela"IC reporting program, on behalf of the cuatemer listed on this form.Gabon Seroducts moat oicaronlcalb Immmit to CIWMB all roCuirad <br /> Information from this reanifout form, <br /> Original - Office Copy <br />