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Comprehensive Trip Log Number Load Information Facility Tire Program ID Site Suff ix <br /> Pick Up Delivery 3 S —❑ <br /> 4769669 B ❑ 000 ® © 00 <br /> Q. u' <br /> Facility Telephone Number <br /> Hauler Tire Program ID / Site Suffix DATE� qq <br /> ao © aoa <br /> ,\ w Wha. ole Tire Count ❑ Weight In Lbs. nA <br /> 0 V ❑ Volume Cubic rlu Fa <br /> Yds. ❑ Weight in Tons fdLa�'Tsu �/\F, <br /> a� Citrlrj: I.cai5 � Q <br /> E Hauler Marne JJ tt e <br /> U) O <br /> HM00 <br /> l1aha¢ ❑ (�6tkm aS I dal er Initials <br /> Hauler T�'e hon ua� 1 (Nle it (CERTIFY THAT STATE F CALIFORNIA <br /> PERJURYOFTHE <br /> S /✓_� 1 -- —------—Whole Tires) AWS OF THE STATE OF CALIOIS TRUTHATNDC - — <br /> INFORMATION PROVIDED ABOVE IS TRUE AND CORRECT. <br />