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2011.10-19 14:51 Golden�roducts 209+6690tiZ "N>:W 11H '61 '130 a ij PaAI ;3;� <br /> vv�vG1v o 1-rr�uu zo C1 Da bUKAF'' I I K L C:UMPAW <br /> P.O. BOX 1 1 '13000 NEWPORT RD, INVOICE <br /> BALLICO, CA 95303 (209) 668-48551 <br /> EDT TRIP LOGO' 1003314- 07128/2011 JR 1 EDT MANIFEST*: 1003314- 00077076 <br /> DATE DRIVERS NIT RUN 0 . <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# 1026678-01 <br /> PHONE: 0- PHONE: (510)60"159 <br /> HAULERISHIP VIA: GOLDEN BY-PRODUCTS / 13000 NEWp,ORT RD.I SALLICO STATE CA <br /> TRUCK a: �' ��� 41C PLATER Uw f 011044: <br /> HAULER EXEMPTION; F GOVT F7 LEA EXEMPT COMMON CARRIER UNREGISTERED HAULER <br /> TRAILER: PU DEL, <br /> SPECIAL_INSTRUCTIONS: <br /> TYPE COUNT Ulm UNIT PRICE EXTENDED AMOUNT <br /> PA ENG R TIRE EA <br /> ! <br /> PLEASE PAY FROM THIS INVOICE-NO OTHER INVOICES WILL BE SENT! <br /> Invoices over 30 days are subject to a late fee of 1 1/2%per month, <br /> which Is 18%annually,or a minIMUM of$1.00 per month, TOTAL <br /> I coNry InM rI try urtaor yw laws Sta10 Of Caufomla <br /> DW Iho informollon poylaoa&aero is Iruo aria mrton. N od0lion,I am avere that falelf)rauon of in)$wolmalim <br /> may ree CIVIL pMallbf W $$5 vldgtbn a!aatNru�pWw panallloe up b U,000 por violation Dor dpy III deftrinad In Pua11a Ravurwo Coco�atian 42M2, <br /> x x <br /> Raalllty Rap n6 'Q Namo(Pf n PaatAty Ropra�nLWva'e Signature Date <br /> CHARGE PAID CK# <br /> WEIGHT CERT 9 NET WT TONS <br /> I annlfy Nd vrdor penally Of porlwy WWW Iho Ion of Iho Stale of Ulfdrnln&tat Ina irlfarmouon pm-koa movo le into ora aerrda. In odGuorn I am owaro mm ralelflaawn v INe INarmation <br /> MrowA In%Jwenslan,tiremollon,rY doriiol of ranow4l of VU Waeto Y"M.& n Aaaletmaan wr—d to PLANE Rnr r=Coda eocaen 427n0 and may rea.N A nvli ponnlli.vp 1n <br /> Tpar day w ridaUon or adrrinieiraavo prnolr:w uo to 55.000 per n�laocu par day as ciowbod aR alit Rowuapo Code aealgn.r20Aa. <br /> PelvoJ00 Namo(Print) Drlvorx Aianalura nelo <br /> 0ent7Wendallty Claim (app)lcable to all pardoe listed on abovol:Ybe weemalienlprovidad In Pan I,Pail II,and Part III of thi3 form shouia be coneldered <br /> �,cut, c rif(dentlal.urvprl�lnry,ondld'u Wt:racroL In A0=dunw wlth'ftda 14,CCR,SaUg '17041 uLora.Groutl any rnvubor of ltto puuu0 raquc,t diadoaura <br /> k '� of Ihtd Inl4rmntlon,I roQuest that CltnmAl3 contact moot IBo adores and tplophonf:ntunberanovo. <br /> W• Electronic Reporting to CIWMB: Golden gy-Roduc:s has boon aumorized by CIWma Io portic4pate in the waste and Qaed Tiro fn elect SOT <br /> elealronly fop*"program. On behalf of tao cuatornw lured on thla form,paldan ByrProduen wiu otoonronleaily banaMit to ommo all mQuirae <br /> Infor=Wn Ifom Ihla m riffeat farm. <br /> Original - Office (YOpy <br />