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. , 4 <br /> Oa CA Comprehensive _. ip Log and Receipts . oopt'ofilewurco•Rocyctuyo aecovery <br /> I .Y RO.adx 12b8,6ocrnmonto,GA 85612-1269 <br /> t;f� �y.. <br /> CalRelsycle E x A M .P L E '1112131 • �` r. m'•rehensive Trip/��gNumber <br /> ` R� J�37559 <br /> w_7w (7 <br /> " ngjINSTRUCTIONS ON BACK OF PART 2 DO NOT TAPE,STAPLE OR DUPLICATE <br /> ey slVning this CA ComprahensNe Trip Log and RacalA the slgnar(s)requ"I that the Information podded on W form wt0 ba cw.Jdand conAdential,propr4atary and trade•.acral.In accordance telth Title,14 CCR,Section <br /> 17041.61 aaq,if•MgkhW Is made for dlsciowra of this tnformaUon,CalRecyCta wsa conbct the algner(s)of Me form at the address and tslapMna manber prmi{ded on this fe"or mattpt. <br /> Vehicle Information <br /> Truck Decal Number Hauler Address C / <br /> Business Name <br /> Address 1 A r' a. {d• '�j/ 1 \M 2 G1��. <br /> a a ❑ City, State and Zip <br /> License Plate Number Stato <br /> M@11D EDE 0D ❑ CCaomiermon <br /> L— r . <br /> 11.11,under pe mity of psrhry w4or the laws of dr stat GJlfprnJa that the J www on provld•d shwa Ia true and correct.In sd6ticrt,I on zr o that lalsifkal�Dds Wonna my result In wspsnsion.n xfibow' <br /> danal of ranawsf W <br /> ' tho Waste Toe Haular Rag Wm!*o p-suanI Pubao R as Cada aect 42aE0 end rnny In chnl panahise up to 3 25,000 par y, vtplatlon or admin,*trT P.I.up S5,DDD per oro bra pa day as h Puhl4 Ro cw <br /> Coda•action 42 1lVSI` Y. (`TVi• <br /> .1 <br /> Driver's Name tint Driver's Signature ate" r <br /> Comprehensive Trip Log Number • • Information Facility Tire Program <br /> w 5.0 37 55 9 --- -C Pick Up Delivery <br /> a <br /> oil ❑'D [I ❑ ❑-❑' <br /> FacilityTele Tran Number . <br /> Hauler Tire Program ID--7—Site ffix ❑❑ / ❑❑ �'❑❑.Fame/Address. <br /> p <br /> _. .. r S DATE <br /> a © Who a Ti�nta Weight In Lbs. _ <br /> Business �y <br /> Q Volume Cubic Yds. �Welght•In Tons t <br /> a Hauler Name City, State and Zip <br /> U Stamp or La <br /> Hauler Telephone Number ■ D Address Same as Hauler nJ f <br /> (N/A far I CERTIFY THAT UNDER PENALTY OF PERJURY OF THE <br /> { Whole Tlr•o) U` 0P TME STATE OF CALIfORNIA THAT THE <br /> INFORMATION PROVIDED ABDVE 17 TRUE AND CORRECT. <br /> Comprehensive Trip Log Number Load Information Facility Tire Program ID Site Suffix <br /> CL <br /> �03 5 9 �- B Pick Up Delivery © © �- DIS <br /> Hauler Tire Program.ID / Site Suffix Facility Telephone Number. <br /> . <br /> _ DATELF <br /> _ <br /> J Whole Tire Count Weight in Lbs. <br /> Mss ` <br /> d I Volume Cubic Yds. Weight In Tans Mss <br /> o auler Name `' <br /> Ci ah Zip' � ' s ��� `�(_ Ut <br /> r <br /> U S r Qin. L EON st , - u �s <br /> 'Hauler Telephone Number ■ Address Same as Hauler r ren, <br /> (N/A for I CERTIFY THAT UNDER PENALTY OF PERJURY•OF THE.' <br /> •i - - Wh01•Tiros) LJIYYa OF THE STATE OF CALiF0RNLA THAT THE ,• ' . <br /> INFORMATON PROVIDED ABOVE 15 TRUe AND CORRECT. <br /> Comprehensive Tr • Log Number Load Information Facility Tire Program IM Site Suffix <br /> 5037559 -- A Pick Up EDeliveryt: 2. �. -' © a <br /> 0 x Hauler <br /> Tire Pr.og-r.am:ID Site.Suff. ix <br /> � Facility Telephone Number <br /> DATE <br /> D 00- Q 4 00 © ��1 <br /> Whole Tire Count E] Weight In Lbs. <br /> ' Facility Business <br /> Volume Cubic Yds. R Weight In Tons ' NaX>r Md}i-d0a_AUTO DLSX#3010 <br /> o H user Name City, State;*W�n Blvd. <br /> � <br /> .0 v(u- �t�Gl(.-I,� I- Sacramento,CA 95823 <br /> U 2 Stamp or.Label OK <br /> Hauler Telepho'Address Same as Hauler f <br /> INA for I CERTIFY THAT UNDER PENALTY OF PERJURY OF THE <br /> ("' I Whole T1re0) LAWS Of THE STATE OF CALIFORNIA THAT THE <br /> tNFOAMATION PROVIDED ABOVE 15 TRUE AND CORRECT. <br />