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CA Comprehensive Trip Log and Receipts 1OW2 PDvpt oox,R ••O,Sooa250, (p� s�seRecovczy <br /> , <br /> E X A M P L E 1 2 3 Com rehensive Trip.Number <br /> ffi oINSTRUCTIONS ON BACK OF PART 2 QQ NOT TAPE STAPLE OR DUPt KATE 5307816 <br /> 8v.b+w 001.a tonprd wW�•THp Lop"R.c4L L•r d-WW OWN Wt"t MVVWad w nw fo to b.wRSldo..d <br /> T741f a N6.fl.rsp+e!a rssW rar r-"•c'owa�of oaa t'orqu2la+.CCReoYUa no raeMxt tM r(U of ttm form 21 Cu•CCnes snd „r+7 and tnW.•cist.N WC—=—.�TtZ*74 CCR.IIwtkn <br /> Vehicle Infonri atlon `"`P"°"°"rt 6ir p �''d on 'fO""w rwC,,L <br /> Truck Decal Number Hauler Address r j <br /> Business Name / <br /> Address - •- - MLTR Company <br /> State and Zip 935 S. Union Sheet <br /> City, <br /> License Plate Number State Stockton,CA 95265 <br /> El Car ieron �2Q9)988-1894 <br /> aaiC•0f1 u902 Papst,c1 P+TLW+t b Pu66e PASWC"COW iKlion 4M� Pr=A I CIVIL h dt U anRf23 M atltli 42 t W awaa Qlal gk;Lcytleri Of Slat 6'110ry1LTtfprf tttpy M=A In CfL <br /> IM 1Myt•Tti Hsdrr m.lr rtata h drll Padtga W M i TS,DOD par'uY,pw rkAalYon m ry ft d V a 1.Pt d nro.nl d <br /> aafimabatM.Pa++rkim�!C 33,000 per YIOluIOn Rar WY td Oari®OA h RISC Rnapcy= <br /> �OSe' j0 G11r/2.c-d Jd_&-lp/ <br /> Driver's Name — Driver's S' nature Date <br /> Comprehensive Trip •• Number <br /> a <br /> 5307-816 -m C Pick-Up, [jDefivewy <br /> , p 4 <br /> Hauler Tire Program ID / Site Suffix (� Facility Telephone Number <br /> •DATE <br /> ®® / �® <br /> LU ®Whole Tiro Count Weight in Lbs. © �o v ® a <br /> Yolumo Cubic Yds. Weight In Tons <br /> o Haule ��1b� /V P C� <br /> U f )986-1614 <br /> Stamp or Label OK <br /> Hauler Telephone Number ROOD [] Address Same as Hauler r <br /> IWA fa ICOMFf THAT UNOEA PENALTY OF PEPMIRY OF THC <br /> -- -- Whoto Tiros) LAM OF THE STATE OF CALIFORMA THAT TIE <br /> PTAM• NFORMATION PROMM AgM tS TME AIfn COMtrCL <br /> I -75�307816 -- B Pick Up Delivery <br /> it gram ID % Site Suffix <br /> DATE F]j <br /> / 0Facility Telephone Number <br /> n �1 <br /> ' w Whole Tire Count ® Weight In Lb 7a. <br /> m 7��°' E Volume Cubic Yda Weight In Tons0 Haul <br /> /� Qz /U��.ry✓,��/�E /�lJ <br /> �� ) 988-1614 � <br /> Stamp or Label OK <br /> Hauler Telephone Number ■ D' Address.Same as Hauler -_j <br /> (N/A for I CERTIFY THAT UNDER PENALTY OF PEPJURY Or TH. <br /> WWo Tit-) LAMPS OF THE STATE,OF CALIFORNIA THAT THE <br /> INFORKATIDN PROVDEn AAIM IS TpM AND CoRr'tCT. Al <br /> L 5307816 -- 14 <br /> Pick U <br /> p ®slivery�-2 . � [2 - f <br /> Hauler Tire Program ID / Site Suffix Facility Telephone Number L� <br /> DATE []IFO] , C�O , DC� <br /> w Whole Tiro Count ❑WBight In Lbs. <br /> I}a.:,►�.s�`�d��s�- <br /> HE Volume Cubic Yds. ❑ Weight in Tons <br /> HauIF "986-1614 <br /> V 1 ■ S00 Ftamp or Label K I <br /> Hauler Telephone NumberDE 0 Address Sari a as Hauler J <br /> . (N/A for I CERTIFY THAT UNDER PENALTY OF PeRJURY OF TME - <br /> • Who{o nMe) LAWS OF THE STATE OF CALFORtVA THAT THLr <br /> INFORl1ATON PROVIDED ADOVE IS TRUE AND CCWRECI;.. <br />