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Dept of Reaourooa R•cycllnp and Recovery <br /> CA Comprehensive p Log and Receipts 1 P. Box 1259,Sacranon,e,CA85B12-1M <br /> GBPS G�8 E X A M P L E 1 2 3 _ ' Com rehensive Tri Number <br /> S$Na 503549 <br /> cxnalTwau(TnwINSTRUCTIONS ON BACK OF PART 2 DO NOT TAPE, STAPLE OR DUPLICATE <br /> By alpntr.p tlda CA Comprenan.Ma Trip Lo7 and R.celpt,V a alpn.r{a)r.qua.t that the Information prorldod on thl.form wfin be conaldered conlldermtal,proprietary and trw&worm.In accordance with TWO,14 CCR,Section. <br /> lTD41 at..e..It a r.eu.at I.mad.for Maclowra of th/.Information,Wflecyde.111 contact U.alpn.rt,)of IN.toren at th.add—and tal.phon.number provldb on thla roan or r..#,L _ <br /> Vehicle Information <br /> Truck Decal Number Hauler Address <br /> . Business Name <br /> City, <br /> Address <br /> and Zip y S <br /> c+vQ <br /> License Plate Number State <br /> ❑ Cage°n L <br /> I cwllfy undw pans o1 1M1 the Informatton proyWod above la true and owed.h addd1w,I am aware that talalr on Of t I,,qn10, <br /> raaull 6n qn,rr ocatyn,w dwdd of lar. d of <br /> iM Wasta Tk Hau R.Qlatrotl an pwewM to W c Ra.o Codes "m 42960 mrd mayll h rive pMel:'H up to S 25,000 pw d y, vb'a'.�on w■denim WN. la.�p to00 pw Ndatl rimy as de.crged In Prtuc Rp3pataa <br /> Coda aectbn 2962 � <br /> Dr{ver's Name rin Driver's SI nature Date <br /> Comprehensive Trip Log Number Load Information <br /> Facility Tire n Program <br /> .5037549 -- C Pick Up Delivery <br /> n Facility Telephone Number <br /> Hauler Tire-Program ID / Site Suffix DATE <br /> lll�� o <br /> w � Whole Tirer Count � Weight In Lbs. 2ap PON <br /> . , f u7S 01V <br /> m I�1,512,17- 7 �. '� / Volume Cubic Yds. Weight In Tons a r ., <br /> E Hauler Name to n i <br /> r? CQSv�17{ <br /> 3 �� ���{ �_. QIP-• <br /> II��uler Telephone Number DEEqRw_EE Address Same as Hauler r mat <br /> O 61[ (Nle for I AWSCERTIFY <br /> OF THAT TATPUNDER0 PENALTY OF PERJURY OF T}SE <br /> p� '`'IIlJ —ll �� /�J Whole Tires) LAWS OF THE STALE OF CAIJFORNIA THAT THE <br /> INFORMATION PROVIpED ABOVE IS TRUE ANO CORRECT. <br /> Comprehensive Trip Log Number Load Information Facility Tire Program ID Site Suffix <br /> 5037549 -- B Pick Up Delivery <br /> DATE <br /> Facility Telephone Number I ^ <br /> HI'Mauler Tire Program ID / Site Suffix <br /> -UPER <br /> Whole The Count Weight In Lbs. <br /> Facility Business <br /> Volume Cubic Yds. Weight in Tans Nai�-/ ,4,4 pusC-K �j DDjj��. <br /> cHauler Name Ci+ ..N`i.'VLL �,0 <br /> y 0 <br /> r 760 Stockton r <br /> V �� t, S `/ At <br /> Q CtafT11J VT Ldtict vr, . <br /> Hauler Telephone Number EmEH <br /> q�iT�Hl�tu'.:w;' <br /> (N/A for I CERTIFY THAT UNDER PENALTY OF PERJURY OF THE' <br /> r�7!•. � I . <br /> r 11.W!Of THE STATEOF CAUFORNU THAT THE <br /> Whole Tlrae}' "� _ <br /> INFORMATION PROVIDED ABOVE 19 TRUE ANO CORRECT. <br /> Comprehensive Trip Log • • 1 Information Facility Tire • •• ■ Site Suffix <br /> 5037549 -- A Pick Up Delivery <br /> riFacility Telephone Number <br /> Hauler Tire Program ID / SiteSuffix DATE <br /> 15 <br /> (U <br /> w � z � a�aaoaooa <br /> ro �-� Whole Tire Count � Weight(n t_bs. . . <br /> g <br /> Facility Business'•-, <br /> Volume Cubic Yds. Weight In Tons Name�s��rP�G <br /> o I u er Name City,;SHAMROCK RECYCLING <br /> 01vCA IIORNIA INC. <br /> S Stam'�0840_ALTAMOAIT PASS Rr, <br /> U a , ER ORE A 9455( <br /> Hauler Telephone Number ■ ❑ 459 �.j( auler Tnn, <br /> O n {NIA for I CERTIFY AT t R PENALTY OF PERJURY OF THE <br /> Whole Tlroal LAWI OF THE STATE OF CALIFORNIA THAT THE <br /> INFORMATION PROVIDED ABOVE 13 TRUE AND CORRECT. <br />