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Dept: of Resourvils Recydng and Recovory <br />CA Comprehensive p Log and Receipts 1 z P. O. Box 1259, Soeraitlonto, CA 95812-1259 <br />CelReeycle EXAMPLE 1 2 3 <br />Comprehensive Trip..Number <br />; ,;x,";(716INSTRUCTIONS ON BACK OF PART 2 DO NOT TAPE, STAPLE OR DUPLICATE . <br />BY slunln9 the CA Compryrma <br />honahe Thp Lop and Recelpt, the signor(.) rvquest that the Iwotion provided on this farm will be considered coni ldentlai• proprl.tsry and trod. secret. to scoordxncs with reds, 14 CCR, Section - <br />IT041 et seq.• d a requed Is made for dl sclaaum of this Inrortnatlon, Ca[Rscycie will comact the signora) of this form at the Ii and tslspho" number pmvid.0 on this toren or mcW. <br />Vehicle Information <br />Truck Decal Number Hauler Address Business v\ 9-5 vek_r�i _ <br />Business Name <br />Address <br />P ® 0 City, State and Zip <br />Ucenss Plate Number State Lk-(�-Cj C C_C.t CG, 'tet S 3 <br />k Li a® I� L L Carrieron . L <br />I <br />cad it; undo, Pana'ty of pol'+'Y under I laws of the Stat t C.luorn!a that the fnlormatbn oY06d otwv. b VVs"coned. in addition. I aware <br />Ihe Wave Tus Halder RegisuaI- Pur..ril to Pud1c R Cods +on 1. and raadt In cMl ponahim up to S 25.000 pw dsy, peat L6 <br />(.,Matt a2 +j PN <br />Driver's Name (print) Driver's <br />5037551 --C <br />Hauler Tire Program lD / Site Suffix <br />-r Name <br />Hauler Telephone Number <br />�0" (-�f7-�N <br />5037551 -- B <br />n1 fslsr"*, n of <br />a euNnnistrnWe <br />/ r <br />J7 i - I - - - 7-1 1Pick Up 'Delivery.- <br />DATE <br />Delivery <br />DATE �o�ao�oa <br />wit Whole Tire Count Weight In Lbs. <br />Volume Cubic Yds. Weight In Tons <br />a � � <br />(WA for <br />' Whole Tiros) <br />l�kl-c, <br />nature <br />mr molt 11wit re <br />, voc bort ixdoval of rarwwal of <br />"'10" 1 .000 violas day m do"bed In Pubiata c RM <br />I U�� / L, <br />-2. <br />Facility Telephone Number <br />a� <br />CC{ . `�s <br />D. Address Same as Hauler., ,n,rlds <br />I CERTIFY THAT UNDER PENALTY OF PERJURY OF THE <br />[AWS OF THE STATE OF CALJFORNIA THAT THE <br />INFORMATM PROVIDED ABOVE ID TRUE AND C.ORRCCi <br />lick Up ❑Delivery IM <br />Hauler Tire Program ID / Site Suffix DATE <br />Hauler Name <br />,A <br />Hauler Telephone Num <br />9� X2.5 b <br />Whole Tiro Count Weight in Lbs. <br />��I E]Volume Cubic Yds•D Weight In Tons <br />t Wtwlo Tln�j <br />5037551 --A <br />Hauler Tire Program ID / Site Suffix I DATE <br />�P F31': l — <br />a ler Name <br />Ha�ulerr Telephone Number <br />Facility Telephone Number, <br />oaa-o®aao•� <br />FacilityBusiness ' <br />N aa; Lp U AUTO D11M. #3410 <br />Cit , otaie yd'tocktonBlvd. <br />Sacr jnj nto; CA 45823 <br />Stamp or t_euel UN <br />Address Same as Hauler:, <br />I CERTIFY THAT UNDER PENALTY OF PERJURY OF TMH , <br />LAWDOF THE STATE OF CALIFORNIA THAM TNE- _=s •,; <br />WCMYaTnY OWMfln carnia tC itJ,a6 aYM NNOCM • • , <br />Pick Up fj;�'D'ellive-iry..0 j] 1A <br />[7] <br />Facility Telephone Number <br />D5 NIF P-PFIRF� RR <br />wLi Whole Tire Count Weight In Lbs. �t \, <br />~ 0 Volume Cubic Yds. O Weight In Tons. I al T�/j}{�d r.u_sU <br />C�Vc�ctv <br />C' w \ <br />Q� of mp or Lahel OK <br />■ F-� Address Same as, Hauler ,rmr <br />(N/A for I CERTIFY THAT UNDER PENALTY OF PERJURY OF THE / <br />Whole Time) LAWS OF THE STATE of CALIFOR" THAT THE <br />INFORMATION PROVIDED ABOVE 13 TRUE AND CORRECT <br />