Laserfiche WebLink
OLSO "N W 'l �101 8l 'add au111 panla�a� <br /> '14 J <br /> Pickup Receipt <br /> 1W6 Spring Ave Pickup bate: 211912013 <br /> Santa Fe Springs. CA 90670 <br /> Hauler and End Use Facility EbT Manifest 4: 1863358 <br /> Truck: 334637 EDT Trip Log #: 422834 <br /> License Number, State: CA/9D97640 <br /> State: CA . Store No.: CN19112 <br /> Decal: 13-03886 EAGLES NEST HARLEY <br /> 13900 S HARLAN RD <br /> LATHROP,CA 95330 <br /> Telephone#: 209/941,0420 <br /> TP ID: 1497832-01 <br /> ITEM QTY I <br /> Trailer: 532811 -- <br /> Whale Tires 123 <br /> Total: 12^11 <br /> cerlify that under penalty of pelury under the laws of the Sute of f certify that under penalty,of perjury under the laws Of thr;State of <br /> Catitomia that the Information provided abeva lrw true and correct California that the information provided above Is true arid correct. In <br /> addition, I am aware that falsificatien of this infcrn'tatlon may result in <br /> surrpansion,revocaden,or denial of renewal of the Waste Tire Hauler <br /> Registration pursuant to Public Resources Code section 42960 and may <br /> result In clvii penalties up to$25,009 per day,per violation or <br /> administrative penalties up to$5,000 per violation per day as described <br /> In Public R"ources Code Sootlon 42962. <br /> Generator Signature Driver Signature <br /> thornas bruce JOPGE SOTELO <br /> confldentlallty claim;The Information provided on this form should ba corisideted confidential,proprietary,and'or trade <br /> oV.1c Date- secret.In mrmrdarce with Tide 14,CCR,Section 17041 et.soq,should any member of 1ho public request dlscfo3ure of this <br /> .� information,I request that CalRecycle contact me at the addreae and telephone number above, <br /> u Electronic Reporting to CelReeycle:Lakin Tire West has been autharlYed by CalRecyda to participate in the Waste and <br /> Used Tire Manifest ED1'elfrtrunic reporting program.on bt3half of the W;tgmer Iloted en thlc form.Lakin Tire Wast will <br /> electronically transmit to CalReeynld all required lnMrnetlon tom this manifest. CalReeycle hers approVed the Lakin Tire <br /> Waat 1:0T form for vse within the waste Tire Manifest gyptem EDT program. <br /> ■ <br /> ■ <br />