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Load <br /> Information Program <br /> Comprehensive Trip Log Number <br /> a 4 7 8 9 8 8 4 -- A Pick Up ❑ Delivery 1 IS] _� a ® ooT1 <br /> Hauler Tire Program ID / Site Suffix n® / / �© Facility Telephone Number <br /> � <br /> DATE J� <br /> N �Q�.Wh�oleTireQa ©- <br /> ®®goo ® <br /> � Count � Weight in Lbs. <br /> Lo, <br /> Volume Cubic Yds. Weight in TonsEl <br /> E Hauler Hame ::iii .•�e� .a,T v <br /> s 7 _S S� cc,r Tv rJ <br /> Xaulcr'seiePhone ,dear-r e Ad$ , c� QW �.1�} <br /> �"'��°-' Initials <br /> (N/A for I CERTIFY THAT UNDER PENALTY OF PERJURY OF THE <br /> v I Whole Tires) LAWS OF THE STATE OF CALIFORNIA THAT THE <br /> INFORMATION PROVIDED ABOVE IS TRUE AND CORRECT <br />