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----- - ---- — <br /> CalHornia In"reW Wast.ManagartwM Board <br /> CA_ Comprehensive Trip Log and Receipts. 10002 P.O.Bo:1269.aacrarmnibo.CAOU12-1268. <br /> !4L,L _ 2T-1 Comprehensive Trip Number <br /> 4.088.255 <br /> WAVIto" ON BACK OF PART 2 DO NOT TAPE. STAPLE. DUPLICATE J <br /> pY elo."thb CA C—prel- ?•T 1p Lep wW R•e•IyL S»•W..(•)n -, DW Sr.Irdenn.Sen provM.d a tldatoem W 0 M eoruld•rW eerdldartWl,peoprMbry arW traa.went In.eeorWno0 whh 1111.;14 C17L 8•etlon. .. <br /> 17011•l aa0.■a r.On•.I b male tw dbeb•un of thb edblimado.%Dn CRR®w1111 earR•et M..fprt•ri.)d Ihb 1—m Ow addnies end rt.pban•money p—Med en Me tern w reoelpt . <br /> Vehide Information Hauler Address <br /> Truck© a Decal Number Business Name <br /> Address DANIELS TIRE SERVICE a a a ® City, State and Zip 1 850 E: Slatison Ave. ; <br /> License Plate Number. State Santa Fe Springs,CA 90670 I <br /> LA LF-1 M I ® M•H .© © Carrier n �J . <br /> I certify under penalty o,perjury under the law.of the State of California Met the information provided above is bile and correct In addition,I m erre ftt falsirioabon of this ormalion may r wspenswl revocation:or denial of renewal of .; <br /> • Waste Tire Haular Regiuntion pursuant to Public Resources Code vection•WandmIt incivil pen.Kias uP to f 2fi,f100 per day, iolationor adnuni•bat W 'sup to ,000 alien per day p described in Public Reswrces t <br /> Code section•2962 ' <br /> Drlvers Namerant Drivees.Signature Date <br /> Load Information <br /> Comprehensive Trip Log Number Facility Tire Program ID sit <br /> e Suffix <br /> Q Pick Up DeliveryIFacility <br /> a- `0 <br /> Hauler Tire Program ID 1,%Site Suffix DATE / Telephone Number I <br /> c .:a a 0 .n H Do.0 0 0 <br /> A tu ❑ Whole Tire Count ❑Weight ht In Lbs. <br /> —�31i6y�raslnss <br /> `m I ❑ Volume Cubic Yds.❑Weight in Tons keF1.fier." d�a7G3 <br /> oHauler Name Ccs '; <br /> � i l bV, <br /> Hauler Telepho <br /> 61 <br /> �• r. A�dress.Same as <br /> -Hauler Number Hauler �, b <br /> (N/A for I CERW r TMT UMMA PBMTY of PMMY of TIfF <br /> Whole The*) LAWS OF TIM STATE OF CALMOMIA TMT THE. <br /> PROVIOm W TR AMD CORRECT. <br /> • • _ Trip Log Number Load Information Facility Tire Program ID Site Suffix <br /> a 4..0.,8 g 2:-5 5 -- B El Pick Up a Delivery <br /> - N <br /> ao y <br /> Hauler Tire Program ID I •Site Suffix Facility Telephone Number. ' <br /> � - DATE �• <br /> a ❑ Whole Tire Count ❑Weight In Lbs. <br /> oao-aa� oo � <br /> f. �>actllQy 13usiriess <br /> � Q � 0 ❑ Volume Cubic Yda.❑Weight in Tons . Mw6alRiddregs. ' <br /> who•10/7 <br /> ,Hauler Name $ytb? ;.:'. '.' <br /> rL 12 <br /> Hauler Telephone Number. y P. �Address_Same as.Hauler _ <br /> I •. (N/A for I 1erT6 r T1ulT inOoI MALTY of PEAaatr.of TME <br /> Whole nm) LAWS OF TM STATE OF CAMOR M THAT THE . <br /> CJ C7 ABOVE IS TM1E AND CORRECT. <br /> Comprehensive Trip Log Number Load Information Facility Tire Program ID Site Suffix <br /> a4 0"8 8 2 <br /> 55 -- A Pick Up 'E] Delivery <br /> Hauler Tire Program ID •I .,Site Suffix DATE j Facility Telephone Number -. <br /> is � ❑Whole Tire Count ❑Weight In Lbs. . <br /> m D' �. ❑Volume Cubic Yds.❑Weight In Tons •v�,aapo/.4d,�>r':3� . <br /> .MaulerName. <br /> ei IJ [� lL S3 .e ,��c��.ai`�6 O� CA v <br /> EJ ddress Sahie as Hauler <br /> Hauler Telephone Number ■ Q n,/ara <br /> A Tor/ UI CMFY TIMT UM00t MIALTY(W Pt3Lultzr IN TM(N <br /> !/ v {• (J .�/ W$OF TIM STATE OF CAUPORMM 7NAT TTM HE <br /> TUM). - C ' <br />