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Dept of Rlsaourcoa Recycling and Recovery <br />CA Comprehensive p Log and Reduipts I P.0,Box 1259,Sac nnonfe,CA85812_1M <br />GBPS�_j_•JrG�8 X A M P L E 1 2 3 _ Com rehensive Tri Number <br />5rar.NCabw .5 0 3 7549 <br />W$M*au(TnwINSTRUCTIONS ON BACK OF PART 2 DO NOT TAPE, STAPLE OR DUPLICATE J,. <br />By abpn4.p tlda CA Comprenan&Na Trip Lop and Rac.tpt, tha alprerfa) raqu..t that the Informirbon prodded on thla forrn mT be con aide ed confldwmfal, Prvprbtary and tn.da wo-L In accordance w•tth Thea, 14 CCR, Section. <br />lTD41 at "q.. N a r.qu.at I. made for dlacbown of tN. Info, r atlon, CatRacycfa wUl contact U. alpnWt,) .1 IN. toren at the add— and tab.pho- number provWb on thea roan or r.cotpL <br />Vehicle Information <br />Truck Decal Number Hauler Address Business . Business Name <br />City, ess <br />State and Zip?KAI <br />ya S c+ vQ <br />License Plate Number State <br />❑Cage°n L <br />I canly undw parr¢ o1 la ttmt the Informatton proyWod above la the and carred. h addition. I am aware that tafalr on oft berme; qn raauS if qn, rr ocatyn, w dwdd of Inn d of <br />iM Wnsta Tk Hau R.Qlatratl an pur.wM to W c Ra.o Codes t'm 42900 mrd mayll h due PMN:'H up Io S 25,000 PW dQy, vbal. w ■denim ntN. la. �p to ,OW pw Ndntl day a. da.crq.d In Pt.•euc Re3o w <br />Coda aectbn 2902 Z - �.� <br />r � <br />Dr{ver's Name (grin) Driver's Signature Date <br />Q .5037549 -- C <br />u <br />d Hauler Tire- Program ID / Site Suffix <br />E I�5�72 — 1d <br />Pick Up r I Delivery <br />DATE <br />uj [] Whole Tire Count E] Weight In Lbs. <br />E]Volume Cubic Yds. ❑ Weight In Tons <br />Hauler ti,auler Telephone Number - <br />61[j C¢� � for <br />" 1 Whole <br />Tlro•) <br />Comprehensive Trip Log Number <br />5037549 -- B <br />m <br />Hauler Tire Program ID / Site Suffix <br />ccG <br />o��Hauler Name <br />Hauler Telephone Number <br />�r�'r, <br />5037549 -- A <br />Hauler Tire Program ID / Site Suffix <br />C <br />ro <br />o HI u er Name <br />N <br />� S <br />U <br />Hauler Telephone Number <br />O ' 1 <br />1 -07 --viz <br />oun g s. <br />Volume Cubic Yds. Weight in Tans <br />(N/A for <br />Whole TTree)' <br />Facility Telephone Number <br />I a f <br />to n Ip . os(�/��Gi <br />Address Same as Hauler, r maf <br />J CERTIFY THAT UNDER PENALTY OF PERJURY OF THE t <br />LAWS OF THE STATE OF CAIJFORNIA THAT THE - - a. <br />INFORMATION Pam-nFn ""jv n TRtat, Awn rnd Rar,r <br />Pick UpDelivery, I I I r(rU U U P <br />❑®/ ®� / �� Facility Telephone Numbe <br />Whole The C t M Wei ht In Lb <br />Pick Up �l,/J`Delivery <br />DATE <br />W Whole Tire Count ❑ Weight In Lbs: <br />Volume Cubic Yds. [] Welght In Tons <br />• {N/A for <br />Whole Tlroal <br />Facility Business <br />PT .p - <br />;�N.PULL #i.0 <br />.,tam 76Ur L-dM.StOCktQn 1w.", <br />I CERTIFY THAT UNDER PENALTY OF PERJURY OF THE' " <br />LAWS OF THE STATE OF CALIFORNIA THAT THE " <br />VI <br />MEN <br />Facility Telephone Number <br />no BOB <br />Facility Business''-, <br />Name�s��rPcc , <br />'city, ;SHAMROCK RECYCLING <br />OF CADODRNIA INC <br />PASS Rr, <br />❑ ly TOwR Puler45S lnN, <br />I CERTIFYN RPENALTY OF PERJURY OF THE <br />LAW'S OF THE STATE OF CALIFORNIA THAT THE Fj74 <br />-i <br />ill <br />r� <br />