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GAtDm)a lfegraw Wtule Muwownsad Bard <br /> CA Comprehensive Trip Log and •Receipts: :10002 P.0:60iT7bO Sae+attwDtD.CA96l1T=-T2ss <br /> _ I- X A Id, o *LIE... € I .2 3 Comprehensive Tri Number <br /> � �gINSTRUCTIONS ON BACK-OF PART 2 DO NOT•TAPE STAPLE OR DUPLICATEF 3 9 710'61 <br /> • - By of CA Coapt A,r V TIV Moa Old .OM�)" "dewato•mElon pyartd•d an than tan srm b ataMOrad mefl0bRh4 ptopYYrT arrd trade•resat•Y ae:aridntw r♦1ar"I*U CCR.B•dbn'•.- <br /> T79Nalata.•lataplwtYOada rex dYdt•aadMY Ylammay 00 ClYr)IBgoCaoga do elprerte)dOb aan attlr addea•r adtullpmaa•el,ar pr�Md•dmna•tar�anealpt= - <br /> .e7.E] <br /> Hauler Address <br /> Truck Decal Number <br /> Business Name <br /> Add,esa anZiCity,State,and Zip.License Plate Number Common: '`.•CarMer. <br /> . .• �.:rl cel0y ar4w p•rWly of ply wider CI•tmn d rr Stall d C ftrrsa Vw ab trdorm•d•n portded awm b ow ell anal in aedidon t am arae Out h!'sil4=w of Crb hftm oilon'rray rare if suspensbn,revactlbn,a deri•t of remi. d <br /> Whta Tire Hmder Rs,W~pwsuant M Puao Resanm Cod•sad=♦2950 and may nada n"P�up to S 25.000 pa day:pet.vloblidri d EQnkt'ah7Jva'p•natdn up ID 15.000 pa violation Per day as Oestrlbed Y PuOse Rcsouras•. <br /> CdOM aCttgn•2M _31:. __,.. .. <br /> �.� X322.407 0178 <br /> :Di^Ivers Name 'rint _ `<'.= Driver's:Slgnature Date <br /> ,.. <br /> Program <br /> Comprehensive <br /> Pick'U Delivery' - <br /> 3971061 p �.0 <br /> Ha Tire Program ID_ Suffer: VFac <br /> tjt-�etepp one Number..` . <br /> • I� , . • DATE, ec 'w-elVlTole TireCount We1gM In t bs."�� lity 6uslness Y. <br /> e_ -� Vowme Cubic Yds. WefghUn Tons •NamelAddress <br /> E �.,.• attd Zip . <br /> g •Hauler-Name <br /> ti Stamp or.Label Oa . <br /> a moo, Q'Address Same as•Haulir' �` <br /> Hauler Telephone Number <br /> . - <br /> (N/Aft 1 RFT TTIAT Iam62 FBMLTt.OF PHiJURT OF T10: <br /> . r W)IDIa ) .LMn OF DM STATE OF CAL/UU6L TMAT•TI� <br /> AMIDIM <br /> i' YS <br /> -pick U Deliv <br /> Site Suffix <br /> Comprehensive Trip Log Number Load Information Facility Tire Program ID <br /> a <br /> p• - 2 R 8.!`�J lam' 0 <br /> ® Hauler:Tlre Program ID /-Site Suffix [[.. Facillty,TeIephone Number: <br /> m. DATE a®� ©L� a ' <br /> C w;Whole The Count WelgM In' r rFaciiity Buslnes� <br /> a_ Via 01 ' + .D Volume Cubic Yds.a Weight In NinSM/kMROCK RECYCLING <br /> E, <br /> auler Name - Cit0 I:GALvfFQRN1A'MIC" -: <br /> .�,•: y.10840:AL'TAMOIiIt-P1►SS.RD. . <br /> AGt/t�Y �, y`� _.; . / stalh1�E13MOi��.tccEjj',,C,A�94550x9745 J <br /> . ` Ulb <br /> AT 1�MYTIESj,4 .'&MFtOFF T W)101iA1A OFTIS STATC a'.C�tsd100a11YTT. 0• > . <br /> LH • •• • •.• s • •• 1? <br /> l <br /> Pick Up :Deram ID l� Slte Suffix Facility.Telephgne Number'BOB ' <br /> .DATEf•Whole Tire CountWe1gM In Lbs.. F �eS3VolumeCubic US: Weight In Tons Ciotoapt ZlOe % � �r3.Stamp or Label.Ok. <br /> 'Q:Adciress Same as Hauler <br /> HaulerTef6PhoneNumber ...`•_ ... ICOMM TtuTumet:elALTrDspeumlroFTiIE . <br /> LM"OF rM STAM OF CAL"MDATTIAT TIM <br /> `•• 6_+ -`'f•/ Y YnfOM Tota) Af0'VE T16� _ <br />