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CalnomIs Integrated Waste Management Board <br /> I CA Comprehensive Trip Log and.Receipts -10002 P.O.Boa 1259,Sacramento,CA 959/2-1259 <br /> IEIXIAIMIPILIEI 1112131. Com rehensive Trip Number <br /> rn"101(""`aesIINSTRUCTIONS ON BACK OF PART 2 DO NOT TAPE,STAPLE OR DUPLICATE 3520438 <br /> BY stem,thr CA Canprehe-N.Trip Log"Receipt.Or sienna)request that the Information Provided on this torn,wD tat cooeld—d oonnd•nwi,acnrrrrY ane Dee•ru.L In•ccordrro••der nw 1st ccR,e-a- <br /> 1TaI at eeR.,n•reeuest I•nra•rr a.at•w,s m w•Inram,uan,er clwYe Mu,onrat the•kn.r(•1 a tYe tun at me.dem.end rtapnam numwr prvNUM•n thI•ram or rewiPL <br /> MMONgalmmmv-6 h I rjel I MT—Mallon Hauler Address F_ �I <br /> Truck Decal Number Business Name 13RANNON TIRE I <br /> Address <br /> city,State and Zip 3733 N. WILSON-WAY <br /> License Plate Number State <br /> .� ..©®' came on: I_ STOCKTON,:CA 95205'. �.. <br /> I asts uMer o,Nwry of P•4ury wdn nr Yrn of n»SYr d GPMN•Uri ur Irrl•rremsUon pmilded atw.e b true en0 mned.ln Wdeim. sat ewor.th•t rYnl,aEs,n M thb IM•rrm,tlbn mry"•stun h tion M dfy as d.* l a denW of nav el a nw <br /> Warr Tin Heiner Rpi•tra•,n puraNU r PUNk R•wury Cad.e•dbn 12960 end nrY"null h elv0 q,tlE•e rat r f 26.000 per day.per vola a WmvJ•trsUem. 35,D00 Par vbrtlm W d!Y n d••ute.a M PuOPo R•saur.e <br /> Cont f•dbn 42982 <br /> Driver's tame(pYnt fiver's Sign Date <br /> Comprehensive . Log Number Load Information .e r Site Suffix <br /> 3520438' =-'C Pickup ❑ Delivery <br /> Hauler Tire Program ID /.Site Suffix Facility Telephone Number <br /> DATE <br /> N Dost-aaaaoao <br /> w Whole Tire.Count Weight In Lbs. . <br /> Q. FFacility Business <br /> 9 9 4 . — <br /> 11010111 r,� Volume Cubic Yds.11 Weight In Tons Name/Address <br /> E Hauler Name <br /> City,State and Zip <br /> " BRANNON TIRE Stam or Label OK <br /> a OTOP. <br /> PAddress Same as Hauler rrrrUICr BIC hone NumberICERTIFTTNAr UNDER PENALTY OFPERJYRYOFTNE <br /> 00).X88-8473 <br /> IN 1A nr LAM OF TME STATE OF CALIFORNIA,HAT. <br /> PWtlDla Tlree) INFOR A N PROVIDED AB 9 Tol. MD CORRECT. <br /> Comprehensive • Log Number • •n Facility Tire Program ID Site Suffix <br /> 3 5 2 0 4 3 8 -- B Pick Up [ADelivery o a o <br /> d Hauler Tire Program ID / Site Suffix Facility Telephone Number <br /> DATE <br /> OL <br /> Whole Tire Count :E]Weight In Lbs. <br /> Facility Business <br /> d 11010111919141 P 11 Volume Cubic Yds:❑Weight In Tons ..Name/Address <br /> o 'Hauler Name City;;State and.Zi' • .: <br /> BRANNON TIREH E <br /> , Star»p br Lab.Sam - <br /> u <br /> -Tele hone Number ■ Address Same as Hauler miOara <br /> (I� Jp� <br /> . oI c a. otSY9NDER."LTY of PEAnIR <br /> 01 Y 1cI rHE 8-8477 uwwCALIFORNIA TNAT THE1TRVINORnABOVE AND COMM <br /> Comprehensive • •• • •• 9Site Suffix <br /> 3520438.-- A Pick Up ery <br /> v <br /> oro-aa <br /> m Hauler Tire Program ID / Site Suffix Facility Telephone Number <br /> . ... ., DATE as <br /> _ � �. : , as© 0000a © <br /> to wwa. N Whole Tire Count a Weight In Lbs. <br /> 1 0 01 9 9 4 fF_j • InL s5i__,e__,, <br /> `w ❑Volume Cubic Yds. Weight In Tonsam <br /> E Hauler Name t}ri6tat G{ <br /> BRANNON TIRE DOD <br /> ERE <br /> � Of?(pwrLb g5Zo'C. <br /> Address Same as Hauler <br /> aider Telephone Number ntn,r <br /> 800) 488-8473 DINS OF THAT STAT UNDER OF CALIFORNIA,ENALTYOF T TTHE THE <br /> \.. .,�!A or uvrs of THE STATE of CAYFONIA THAT THE � <br /> f.A OIB:TIna INFOR=PROVIDED A1102 ITRDE AND APER. <br />