Laserfiche WebLink
AOL All <br /> Callfomis Integrated Waste Manep•rent Board <br /> CA C_o_mprehensiv_e rip Log and Receipts 10002 p.a.�=� �» .�s�12-T�a <br /> ':g•;• LC X 1 A M j P i t_ C; ; 1 1 2 1. 13 Comprehensive Tri Number <br /> -' . '3957121 <br /> 060b�(1 INSTRUCTIONS ON BACK OF PART 2 DO NOT TAPE STAPLE OR DUPLICATE " <br /> BY.w a dib CA Compre"folvo Trip UV Ina ROMIK ae eWtwirM nyu..t MW d a hrfere prwfk*d m"form wM in com W red cordk•noH,pnopMha SM trade eeerat m aerbrdarrw wM 1Ttf*,14 CCR,D.crbn . <br /> •Tat M ee4.Q e n pop b mem for dbcb•um et Ude sdarraaGorr,tie Curl®WO eorrtx!the sWrerhl a Orb tort id the adorns and telephone ruenbr podded on fhb toren or mcdpt . <br /> o a v orma on -Hauler Address 1 �a/q l <br /> Truck Decal Number Business Name �`-L� �� "1 R- Czyn�E-�� �..• !� <br /> ® <br /> ORN &H .: Address <br /> City,State and Zip, <br /> License Plate Number State <br /> I common <br /> . I certify under perwry of pedury urimr the laws of the state of cadornla met the tnroraradon povHed above Is true end oan•ct In eddlill I em-mm OW rahlitetlon of ails n1iorrnabon may mutt in eurpennlon.revocation,or denial of renewal of th <br /> Waste Tire Hauler RePlatration punuanl to Public Resources Code section 42WO and may newt in clivl1 pwmMe•up to 125,000 Per day,Per viQl•1on or sdminlsuaave penafts up to 18.000 pef violation per day as ci ncribad in Public Reaaurcea <br /> Code..5-42962 <br /> Drivees.ift rat Driver9-SIg to Date - . <br /> Comprehensive Trip Log Number Load Information Facility Tire Program ID Site Suffix <br /> 3 7121 -" C ' Pick UpElDelivery 0 07U 0 <br /> 95 00000 <br /> � � <br /> Hauler Tire Program ID I Site Suffix. DATE on./ <br /> .00Facility Telephone Number <br /> wV [ Whole Tire Count .Welght In Lbs. <br /> 000-0000000 <br /> �cillty Bust ass <br /> Volume Cubic Yda.E]Welght In Tons ll Addre bO <br /> gHauler Name City, ateStamp or b ` <br /> Hauler Telephone Number E] Address Same as Puler <br /> J <br /> (N la for I rater nMr Ulm"PENALTY of PER Rmr W THE <br /> • '. ,.nom) uwa of TM 8TATs OF CAL"MIA nuT THE. <br /> Comprehensive Trip Log Number Load Information Facility Tire Program ID Site Suffix <br /> x'9.5 71.2,1 assel Pick Up., <br /> uDelivery <br /> Hauler Tire Program ID / Slte Sffix Facility Telephone Number,Rn� � <br /> DATE <br /> � �� <br /> - <br /> Whole Tire Count .❑weight In Lba. . <br /> Factlftyw4nWb it Commercial Tire . <br /> Volume Cubic Yds,0 Weight In Tone NametA¢�gt�T j 1A/IICOX ltd ' <br /> Hauler,Name <br /> City,st�att`�CA 5215 <br /> Stamp or-Label OK, E <br /> Hauler Telephane.Number,•• i []"Address' Same as Hauler J <br /> t i{ tN!A is I CERTIFY THAT udmrst tHAtTr OF pauuRr or THE <br /> .fit .g 3 ('= c\j�S1 Whole Ttt4i, LAIN OF 1M BTAM OF CALWOMA THAT THE <br /> Comprehensive Trip Log Number Load Information Facility Tire Program ID Site Suffix <br /> r <br /> 3 9 5:7121 --- A ` Fy], Pick Up Delivery IM OR U 9 T E <br /> Hauler,Tire Program ID t Site ffi <br /> Suffix. DATE j {'ids(/�Jyl''t! ;.� Facility Telephone Number.: <br /> ®Whole Tine Count ®Welght in Lbs. r t lA4p �b �-I}5-x-1 G 5 <br /> ..m.. (� 11 Volume Cubic Yda:aWelght In Tons N / <br /> E puler Name Ci , t D nd' o A ,y am �D <br /> I ` d Sta p arQ 656 A..j­ <br /> r <br /> TO(\Ik C `' <br /> Hauler Telephone Numbe „ o Address SaHau+ � —1 <br /> /JJ �. (N Afor 1 CERTIFY THAT UMM PENALTY OF PERJURY OF THE <br /> . <br /> .i_.• C � C/_ Whole nres) LA"OF.THE 8TAT8 OF CJ119'OR111A THAT THE <br /> i d <br />