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GINOmiB IrdegratW Waste Mam9ement Board 1Y <br /> . CA Comprehensive Trip Log and Receipts 10002 P.O.Boa 125gfcnmento,CA 95a12-1259 <br /> E X A M P •L E1112131Com.rehensive Trl Number <br /> r,awa-i(,w-q INSTRUCTIONS ON BACK OF PART 2 DO NOT TAPE,-STAPLE OR DUPLICATE <br /> 3520548 <br /> BY&Igning Mle CA ComVreneneM Up Log•W se ri L gM.Igmr(s)rNPNeri M•I IM Nd«mWn PraNJW on Mb lorrrl rdli M tonelWrW conNwng.4 Pr0PrFnArY•W U•W WreL M emerd.noe MM TIM.14 OCR,Seedon <br /> 17011 M eeq.,ry e reRunl W nuM 1«WWmun oN U1i InWrm.Un.Me CIWMB YA11 mmeel ih.Ien•H.)o/Mie form R M•6" end WIWWrn numMr proVWed n MN fern«mc•IpL <br /> ec e;n onoat on Hauler Address 7 <br /> t® <br /> Truck Decal Number Business Name' ANNON HFIE <br /> 09 — © ®u g E Address <br /> city,state and zip 3730 I`J. 4'!/;LSJ�`d W,qY <br /> License Plate Number State .Common STOCKTON, CA 95205 : <br /> © © Id H 201 F U . Carrier _ <br /> I«NIY Inow Penney d Pejuly undo the­% Me$We of Caebrlle Uul do—on n Pr W•bon Is bite and mrrL In WM m.I err,even"I le.Meeow CO W,I do—d n mry nrwll In euepenNm,ni n an,,r denIM of;.—&1.1 tlN <br /> .We-Tin Hauler ReglseWon pun In P WG Rewuw.CoOe ee« 12960 eW may mW In tl q Mee W W 526.000 N>•r a•yrP«Mda64,or•dminl.Irallvs neM up n Ss,000 per NO Unn Per dey e.awl n P.BdRaa«nm <br /> N:oM eMnn!2g62 0808007.0757. <br /> D five s Name rint fiver's-SI nab Date <br /> NumberA Comprehensive Trip Log ..• Information Facility Tire Program <br /> . . ick U P Deli've ry,Pa —�`0_ 3520548: _ C <br /> dt.., . anlI_'�d/.�� /•'a® Facility <br /> Telephone Number <br /> Hauler TireProgram.lD -,SiteSuffixDATE <br /> - - <br /> a�aav oo� <br /> w Wliole Tire.Count .Weight In Lbs. <br /> Fcility Business <br /> m: Volume Cubic Yds. Weight In Tons .. Name/Address <br /> :E, p <br /> Hauler Name <br /> City,State and Zi <br /> RANNON TIRE a© p �. <br /> 1Sttam or Label O.K <br /> � �I r Te,l{ one Number ■ '1 yl Address Same as Hauler ,Nmar, <br /> � �'F8.8473, i (N lA for 1FY TNAT UN DEA PENALTY PER1URT OF THE <br /> WHOM TIME' LAWS OF TRE STATE Of CAUFORUA THAT THE <br /> M RMA VIDEO AR ISA DCO RE <br /> Sfi 17• •• 7DATE <br /> • • • •• <br /> 3520548 -- BUp . [:] Dell very <br /> d Hauler Tire Program ID ./ Site SuFacility Telephone Number' <br /> cc <br /> / Eld <br /> m `_s w lyl Whole The Count Weight In Lbs. �� <br /> ♦ T I' lily Bu xtess� .1 <br /> d :. ' 1 4 O 1 :,.O Volume Cubic Yds. Weight in Tone ' ,N, r e�1�de5' <br /> Ha'uler Name 1^4Y1ie(A 6l ZdW^b/`� _ T/e <br /> BRANNON TIRE , C Stem�o(,Vkp� U.`3W <br /> or Label OK , <br /> :Hauler Tele hone Number 000NEMs E �.Alidress Same'as Hauler <br /> - (N/A l r11 I CERTIFY TUT ATE.O PENALTYCALIFORNIA PERJURY E THE <br /> 8 ••t V ` W NOM T11N) LAWS OF THE STAT!Of CAUFOMITHAT THE <br /> INFORMATION PROVIDED ABOVE N TNUE ANp CORRECT. <br /> Comprehensive •• Number Load Information Facility Tire Program ID Site Suffix <br /> 352:0548:-- ANPICkUp . [] Delivery <br /> Hauler Tire Program ID / Site Suffix Facility Telephone Number <br /> zDATE — l G <br /> .-_ wa Whole Tire Count Weight In lbs. <br /> ® ®© HNOMP <br /> IFWde r <br /> iu Volume Cubic Yda. Weight In Tons N <br /> EVHauler Name Cq(Stk&and ZpL P� < <br /> ANNON TIRE St m cA �s?66 <br /> oaler Tele hone Number � Address'Same as Hauler ma/s <br /> (8OO) �8 V_84 B 3 (N/A}or I AWS FY TUT UNDERCAUFPENALTY Ie PERJURY OF THE <br /> WHOM Time, UW9 OF THE 8TA1E OF CALIFIXINU TNAT TXE <br /> INE;:;ATION PROMED ABOVE 13 TRUE AND COFJRIECr... <br />