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SECTION B ��v <br /> S--U-_S-ED'-rUHA6 �&--4411 FCL RPOSES�|GCG�8�79886V,O1 mV-|HF_n-_ <br /> [-| YES �^= '~=�°%^N0 ' <br /> 7 IS Y() 10 . |N3PURPO5ES: iGC60793.7Ou� <br /> | l� UnEDEAL[O [l AUTO /� . __---- <br /> "|/|^.V\6i"k`C'xk,k'WnsAtilt)Dismonilo,oxnoypoison onVoo.x|ill U.obxsinexsoUbuying,scUi/g.onho|i,,Uiuvchix|eso[o <br /> /vr`",pi"v|it)ho"`yi,^.nn|vo'|o, this code for dv`|xvposrof dio/hnn(|i?qthe same,who buys or stills the integral por(pmWcomponent <br /> mxoxk.|, Ux.o,`|' i/`wdxit/'vinpar . mdeals ixosn � <br /> d /^vo,md� �y <br /> l mir iixii���----�i��-� -- 9�DAYS�iGCRG79S.7OVN] <br /> [lyE8 NO <br /> � ii\iIS`1 HE BER7OF I IRES-STOR <br /> TIRES <br /> � |,;iiif K—FOR THE STOCKPILES ISSUED BYTHE BOARD?y3CU6/HH.OVU0yG; oo/oo.o5(u)] <br /> FlYES 1161 7r <br /> o |. |Vc«/E THENUMBER OFTIRES HANDLED ATTHE SUBJECT PROPERTY|GCGS78971(d)| <br /> (SJORED)' (STOCKPILED)"- -- -------- ---� (u/uruuEu) '' <br /> ' U"' *m`|mr of 'insmmn' each nmnU, oqxa|n the |mn| brought tothe property during the 13 nxmd`np/kv \othe (late n| filing this <br /> with ||mBoard divided by 12 ox`o hv. <br /> ||".number,/"ck/ i|,droohmon|hvqoo|xU`vtotal brought lnthnpn4mriyeenhmonth for temporary storage during(lie 12mnn(hoprkx <br /> o.U.,do/noffiling this registration with the Board divided 6y1% mnn1ho. <br /> U"`"vo`!v`nUqxn, |nlono|'nnnnU`equa|sthpmto|hrexromovod[rnm|hepnopo,\ydurinViho12mou1hpp,iov8oh|ing\hisrogist,obnn <br /> wi/hUx! 8m/n/divided|w12months. <br /> �� — F Kn�TH0DS USEDn� SHRED, PROCESS, RECYCLE' RECLAIM, INCINERATE, OR REUSE vx*S/E TIRES ON THIS <br />^ YUUPERTY(if needed, osnadditional oog°o)[GC GS789J1(g)/ <br /> I C.Ell I IFY UNDER PENALTY OF PERJURY THAT THE STATEMENTS CONTAINED HEREIN ARE CORRECT TO THE BEST OF MY <br /> KNOWLEDGE. ANY PERSON WHO KNOWINGLY SUBMITS FALSE STATEMENTS TO THE BOARD SHALL BE LIABLE CIVILLY TO THE <br /> BOARD I'N AN AMOUN1 NOT LESS T HAN S 1000 NOR MORE I HAN S 10,000 PER DAY FOR EACH DAY THE FALSE INFORMATION IS NOT <br /> CORRECIED. JGC 66799.73(b)I To be signed by the property Owner or Agent and by the Operator. <br /> ';IGNA111111 0I OWNI-11 Oil AGLNI SIGNATURE OF OPERATOR <br /> if �,()(I W01 It.0 1 IKF A COPY OFAR 1843, T HF CAVroRNIA TIRE RECYCLING ACT,PLEASE CALL THE CALIFORNIA INTEGRA TEO WASTE <br /> _ <br /> -- ------ <br /> ^ <br /> m4AN4GrMENrBOARD Ar9/6/'322-3330 <br />