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C Comprehensive Trip Log Number Load Information F 'ity Tire Program ID Site Suffix <br /> 3958653 -- A y1pick Up DeliveTF <br /> Hauler Tire Program ID / Site Suffix DATE f CL <br /> IV <br /> ility Telephone Number <br /> . .LU <br /> 0. Whole Tire CountWeight m L <br /> O 2 � 1 <br /> m O Volume Cubic Yds.O Weight in Tons }ante/AddresT. �p <br /> O "aL!I$r Il2filE? �State E (�cJ1'h , <br /> vr 1 'N'Get t:a j Co, 952,S1 <br /> i34T4r <br /> Telephone Number a � � ■ �� Address Same as Hauler <br /> N/A I CERTIFY THAT UNDER PENALTY OF PERJURY OF THE <br /> ( <br /> N/ �Ir LAWS OF THE STATE OF CALIFORNIA THAT THE <br /> INFORMATION PROVIDED ABOVE IS TRUE AND CORRECT. <br /> t U'� <br /> r� � <br /> .3 <br /> L1 <br /> �I <br /> i <br /> FT- <br /> Customer Signature: f <br />