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CalNomla Int"reAW Waste Elsnapem.nt Bold <br /> ..... CA Comprehensive Trip Log and Receipts. 10002 P.O.Boa 1259.5--to,CA 95812-1259 <br /> E X A M P L E 1 2 3 Com rehensive TripNumber <br /> c+wire",w(`"",oosl INSTRUCTIONS ON BACK OF PART 2 DO NOT TAPE,STAPLE OR DUPLICATE 3 5 2 8 3 9 3- - <br /> BY.Ie.inE Ull.CA C—pr.lwR•Ive Tdp Log.e!R.WpL ei..Ig—J.)r.q—tlnt Ur Irl.omutlon P.1'ld•e m W.ferrn.0 W ca so nod aadM.nWl,DmI. rY Aral s,.e•..m•L M•crnrda 11 - <br /> 17041.1q.e.wq—hr mad.b dlsei—a OftNd•rm.Uon,el.C1WNB.11�me�n.�.1wNr1.1 a W.lain a neN <br /> —soe ...ne Wh—name.P—Ided On eds lanma ,,L o..1•CCR.Sadbrl <br /> e c e n ormat on Hauler Address </-/L/ S- p�-111�� l JIJ <br /> Trude Decal Number Business Name <br /> © Ad&ese T6L '�a),»v � ul`186 <br /> S)D �/—),C)N <br /> License Plate Number State City,State and-Zip <br /> rr eron <br /> CaJ <br /> I eadN arid.. ay <br /> a 0""unM ft Im a ft Bata a GYbnW N.1 e..VUorrn..Upn X11 4W.Dov.N•u..M ral.rx.In.dNdon.1 en.w.n 0w lw•kallen a W.Infam•0on m y k wap.rlYen.­"Ia aenW a rarNFl of eN <br /> Waw M Naul.r R.9btratlon purw.m b Puak R•.wm..Cae...tlbn•]BeO.rd mry nwn M eM paWOu up m S 25.000 pP e•Y.par vbl.em a.dminbfNly.p.n.Na•up b SS.000 per vbl•llon P•r e•Y r d.svW.d ti FYAWc Re.ourcw <br /> CoOe..abnv2se7 <br /> 1/�L�/ ata �'REZ 0830307'0583 <br /> Driver's Name(print Driver's Signature Date <br /> Comprehensive Trip Log Number ..• Information Facility Tire Program <br /> 3528393 =- C Pick UpDI -Lelivery <br /> w Hauler Tire Pro i•am IDS/..Sit Suffix 1 Facility Telephone Number <br /> ¢ 9 DATE <br /> Q0/ <br /> ao ao <br /> ono-000a000 <br /> � 11 <br /> U [3.WholeTireCount '' WeightInLbs. <br /> 2 "" Facility Business <br /> ai 3of / . I Cj)Volume Cubic Yds.o Weight In Tons Name/Address ; <br /> o HaulerdName 1 City,State and Zip,. I <br /> Stam or Label OK <br /> V Hauler Telephone Number �-- ED ..o Address Same.as Haute. 1110,/. <br /> ),� <ji (" <br /> f (N 1A for I CERTIFY THAT UNOEn.PENALYY OF PERJWY OF THE <br /> G /J Whole nn.) U"OF THE STATE OF CALIFORNIA THAT THE <br /> INFORIWTON FROMED ABOVE CI TRUE AND Co... . <br /> Comprehensive Trip Log Number Load Information Facility Tire Program ID Site Suffix <br /> :3'S 2 8 3 9 3 -- B Pick Up a Delivery <br /> d Facility Telephone Number <br /> Hauler Tire Program ID /.Site Suffix I <br /> H <br /> DATE. <br /> �_ ; r aao-000aoa <br /> w <br /> a 0 Whole Tire�ount a Weigllt`In Lbs. <br /> m-. ..Cubic <br /> rF-ility Business <br /> v <br /> E .. t❑ olue is Yds.-E]We . <br /> ight in Tons Name/Address <br /> " i <br /> o Hauler Nam` -- City,State acid Zlp. _ <br /> V G Stamp or Label OK I i <br /> p o� 0 J <br /> Hauler Tele hone Number ■ AddresaiSame as Hauler nhla„ <br /> "(N/ATfor " I CERTWY MAi UNDER PENALTY OF PERJURY OF THE ._ <br /> • - Whole TITee) LAWS OF THE STATE OF CALIFORNIA MAT THE <br /> 'MFORWITON PROWOED ABOVE f3111UE ANO CORRECT. <br /> NumberComprehensive Trip Log <br /> •rmation Facility Tire Program ID Site Suffix <br /> 3528393 -- A Pick Up Delivery — <br /> ❑ 000aaaooa <br /> Hauler Tire oa Program ID /.Site Suffix DATE Q / 1 / D Facility Telephone Number i o0 oa <br /> a Whole Tire Count Weight in lbs. © � ®� <br /> C. Facility Business <br /> d ( I Volume Cubic Yds. Weight In Tons Name/Address <br /> E Hauler Name City,State and Zip <br /> Stam or Label OK <br /> U Hauler Te Number a DEERDE Address.Same as Hauler YRm,Ys <br /> IN/A for I CERT"MAT UNOen PENALTY OF PERIURY of THE <br /> Whole lite.) LA�OF TM!$TAR OP CAL6oRIM 7 THE <br /> INFOR.AZ PRpyI0E0 ABOVE M TRUE ANO CO..E <br />