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Dec 27 2016 16:56:55 EST FROM: F?M/58846309011 MSG# 1736935491-005-1 PAGE HH6 OF H62 <br /> `0Pickupft�ocnipf <br /> ,..- <br /> 15305 Spring Ave Pickup Dato: 2/18J201S <br /> Santa Fe Springs, CA 90670 <br /> Hauler and End Uso Facility em Manifest iY: 1101335040 <br /> Truck: 334,637 EDT Trip Log#; 507736 <br /> Licorice Numbar.. Stat a:CA J 9D97640 <br /> Doc,31 CAStora No,:WA01554 <br /> c31: 95-02486 WAL MART S TOCKTON <br /> 3223 EHAMMER LANE <br /> STOCKTQN, GA 95212 <br /> Tulep bons:2091473-3436 <br /> S'F'ID: 133'i 802-09 <br /> ITEM .. �...._�._.-.�.,� N - <br /> Trallor:2997r <br /> Whole Tiros <br /> f cotdfy lh4w under penaliy of perjury under the 10%ve of the atn,a Of I earthy that undar portaliy of perjury Lmdar the laws of tho Surto of <br /> Callfaml t Iht,l Itte inlprmottort pmvtded abova b eue krid wrrecl, Calffotnia that the IrAgrnallort pprtooyAod abovo Is true and vormai. In <br /> addition,I am aworo 11141 falimamlcn of this Irtfpmr nton Ina�yraovn in <br /> suupenalon,revocaWn,or derdal of renewal of the Waste Tka Mauler <br /> oiiin civil <br /> g� putsuaml to Public Rosatgv n"Cock PiWa on 42040 and moy <br /> 64bttaltloe up to$26,t)04 per dey,p%r vlolatkin or <br /> adminis1rpdy0 penaltba vp 10$5,000 ppaer In61a110n Dor Clay 00 deaWbed <br /> trt 1>ut>Ikl rteaw"o corl4 s601lrfrt Q%2. <br /> Cineretor Signature Driver Slri*turo <br /> crok tdrt� JORGE 20TELC <br /> f <br /> ✓ I +'rt r' J <br /> Cw,lidontlallly Claim:1"ho Informailan pmvidwd m thlutorm bhouk,.0a wnsdorod cortfoonilal,prop of'ar,and/urtrade <br /> R mmauun c rogilQ Maeo ltCG�OGyda Gar,aRvtt n1a D tho w a s,s an else a nuamberQtlova rnqupat ttciosuro of IhIM1 <br /> memtranlc INpoeemo to e4moey¢Ier Lawi,'rite Wen,ham baan ovlho,tzed by CaJr2wyCIW to Jartlolnplo In t"Waula and <br /> Used Ylro Mxnllow EDT elmowllo mporiinu prtroprarn,On bahalt.of the cumomar tietdd on thio farm,Latdn Tiro Worn will <br /> elwArwica"V trunnmb to CatRovyclm all t%q irod o1ofmisuon from this mmntraet, C,alRa yWo has approved t1M LmkUt'r1re <br /> West CtST form tor veo witttln thq W;wo Tim Morweist uymorn 60T p,oprtarn, <br /> I <br /> fi <br /> 6 <br /> k <br /> a <br />