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Comprehensive Trip Log Nurnber Load Information Facility Tire Program ID Site Suffix <br /> 3248624 B Pick Up ❑ Delivery a ® �-❑ <br /> Hauler Tire Program ID ! Site Suffix ❑� / ®� / ©� <br /> 0 <br /> Facility Telephone Number <br /> DATE <br /> w <br /> la <br /> Lu Whole Tire count ❑Welght in Lbs. <br /> 3 G 3 1 ~ ❑ Volume Cubic Yds.❑Weight in Tons " `► T a' <br /> -0 <br /> o Fial ler Name <br /> E DOD R4�- <br /> PE <br /> Hauler Telephone Number ■ �� Address Same as Hauler ;,,;f;s <br /> (N IA for I CERTIFY THAT UNDER PENALTY OF PERJURY OF THE �j <br /> S7 Whole Tires) LAWS OF THE STATE OF CALIFORNIA THAT THE //G <br /> INFORMATION PROVIDED ABOVE IS TRUE AND CORRECT. !� <br />