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CA Comprehensive TCalf—la MOeerated Waste Management 5-1d.::. <br /> TO Log and Receipts 10002. P.O.Boa 1259.8aeramento.CAM12_TM ; <br /> E X A ra,i P.L I IE 3'• 2131 — _ comprehensive Trip Number. <br /> INSTRUCTIONS ON BACK OF PART 2 DO NOT TAPE.STAPLE OR DUPLICATE <br /> 3935727 <br /> 87.knbW nes CAC—PM—Ne Trip Loa and R.c.IFI.M. '(.)ropuutnMth.mronn.am Pno'deaeen mb1wm 048-rar M.W—dld. . <br /> ,17041.t..p:8.r.panlh mad.to,aMC105an ortlra.tmeml.tlan,tll.CAY�MO oalmetnn.hFRR.)dlhh Nnn eUM.dmu..trd rdf.l Dr.Pn•I+q eW bee...c..t In.aordRiq RN,TmA1.GCIC8.ollon. <br /> VehiCBInformation adWtN numbw°lo"N.d m mb fwm M" Ipt' <br /> Truck Decal Number Hauler Address <br /> Business Name' BRANNON TIRE <br /> ® ®— <br /> P <br /> .©� ® ® Address <br /> City,state and zip 3730 N..WILSONWAY <br /> License Plate Number State <br /> _©® 0"Carrrrie► <br /> E ®®.© ®_ " STOCKTON, CA 95205 <br /> .l randy under penalty Of PerlurY untlerthetaws w the Stale of Califomia that the irdomiab-provided above 1.true and correct In ad,i llon,I am re that falsiPcallon of me mformallon IW mWI In auslxMIM.n—allon,or.tlenlal of renewal of th <br /> Wash T72 Hauler Reghoa0on.purs�u/aynl/to PublieResourc Co/da} aloe e2960 and may rewa In dWl-penaldea up m S 25,000 per dey,per v <br /> eS ionOr edminlstreliva Oenalties.up to 45.000 Per violation per day es tlexdbetl in Publle Resources <br /> UC�Y u"iii jZ <br /> Ddvere Name Tint er's Signatu Date <br /> Comprehensive Trip Log Number Load Informatiorf Facility Tire Program ID Site Suffix <br /> :P <br /> 3 9 3 5 7 2 7 -- C~... . F1Pickup 0 Delivery u [i o ri <br /> F.. .0,6 a 'Haule�Tire Prfgrarri ID / Site"Suffix' Facility Telephone.Number <br /> i <br /> []0./ 0oDATE j i <br /> A w ❑Whole Tire Count Weight in Lbs.. <br /> 000 0000000 <br /> Facility Business <br /> 0 11 9.: _ O Volume Cubic Yds. Weight in Tons me/Address <br /> ' City,State and Zip <br /> MAAAAAMON TIRE <br /> y a � Stamp or La'bel OK <br /> 0 mi <br /> Address Same as Hauler mss _j I <br /> 3 - t eFmo-Y TMT uMDEIt rta.pLTr OF FEIYURT of - <br /> .. (N IA for LAWS OF THE STATE OF'CAl60RM1A TINT THE <br /> Whole nmol JJ <br /> .^:.. - dFOlarA110N['ROVIDm UE AND CORRECT. <br /> `IComprehensive Trip Log Number Load Information ility D <br /> ..f <br /> x <br /> 3935727 -� B Pick Up Delivery <br /> Facili <br /> m Hauler Tire Program ID /`Site Suffix <br /> DATE ty Telephone Number <br /> cc <br /> ©�/ / ®. I <br /> e a;®.Whole Tire Count a Weight in Lbs.. <br /> r° � j f <br /> r r eS <br /> m 4 01 : p Volume Cublc Yds. Weight in Tona �,f�, 'ddr® s; <br /> E Hauler Name' , - <br /> wh Y <br /> BRANNON TIRE <br /> .���S3.t�1l�r ie%�l}T" �4 P - ■ � Address Same as�Hauler ��y <br /> V��."''�8 ��73- (NIA for .I CF1rrD'Y THAT aroel F91ALTr eF pEp,nmr oa,aE� - <br /> whole nrea) uwa of TIS STATE of CatnvRMu THATTIIE, <br /> vsoRrAiiDN PRovIDED At70VE m ilio¢endo tnRREcr. . <br /> Comprehensive Trip Log Number Load Information Facility Tire Program ID J:'I <br /> a <br /> 39357-27 -- A. .+ [APickUp. . [] Deiivery <br /> Hauler Tire Program ID / Site Suffix DATE RM. Facility Telephone Number <br /> Whole Tire Count OWeight in Lbs. <br /> 0 1 1 1'91'.p 4 _ 0 1 ' �cirity Business ¢. <br /> ❑.Volume Cubic Yds.❑Weight in Tons -��C• i <br /> E Hauler Name bi tags an t i <br /> BRANN.ON TIRE <br /> Hauler Teiephnne Number a 000@5M ED Q A Tess ei�rrrL'as yQia+il , <br /> (800) 488-8473 (N/Afor I CEITM TMT ONDIM PMALT OF PEIUM <br /> Whole nreei ulln OF TM STATE OF CA1lFORWIA THAT TIB <br /> ORORYA7101/ OVIOEp A w TRIfE AMD WRRER. ' <br /> FILE <br />