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'N/A fGi I CLP IFY THAT IINI UR PENAL.I OF PFlut-IRY OF 1EIE <br /> . �VS7U1c T7rCS� IAVIS OF THF STATE OF CAI,IF( iNnT IFi[. <br /> INFORMATION PROVIDED ABOVI,IS [RUE AND CORRECTSuffix <br /> _ <br /> • • ensive Trip Log Number Facility Tire Program-10 Sit- <br /> Pick up Ll <br /> Delivery <br /> Hanle► Tire Program 1D i Site Suffix i <br /> Facility Telephone NUmber <br /> � ®ATE E EDEl <br /> � •UI � <br /> Lu Whole Tire Count Weight in Lbs. <br /> e +� Volume Cubic Yds. Weight in Tans <br /> O I ` <br /> U <br /> � Initials <br /> (N/A for I CERTIFY THAT UNDER PENAETY OF PERJURY OF THE <br /> _ - Whole Tires) LAWS OF THE STATE OF CALIFORNIA THAT THE <br /> INFORMATION PROVIDED ABOVE IS TRUE AND CORRECT. <br /> Comprehensive Trip Log Number Load Information Facility Tire Program ID site isdffix <br /> 4 ? r g -- Pick Up ®slivery0 0 E 0 11 U_ [] <br /> c; Facility Telephone Number <br /> Hauler Tire Program ID 1 Site Suffix <br /> � DATE <br /> IV <br /> "IE ' D 000000 <br /> LU F Whole Tire Count ❑ Weight in Lbs. <br /> ® ~ D Volume Cubic Yds. F] Weight in Tons <br /> O <br /> n f- <br /> s _ <br /> ® Initials <br /> (N/A for I CERTIFY THAT UNDER PENALTY OF PERJURY OF THE <br /> Whole Tires) LAWS OF THE STATE OF CALIFORNIA THAT THE <br /> O M ON PROVIDED ABOVE IS TRUE AND CORRECT. <br /> o Li U 0 <br />