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�_. Comprehensive Trip Log and Receipts 10002 <br /> /�._ _...............!..... .-. _...... _.4_..___.. GlFfam,a I,tt•gnt•d Wast. Rt Boafn <br /> M P.O.P O Box 1249,8acram•rt4o CA 4b812 1 Zd9 <br /> W ��,A� P LL ; I L Y <br /> Comprehensive Tri Number. <br /> _ _ 5 n C <br /> c rwINSTRUCTIONS ON BACK OF PART 2 DO NOT TAPE STAPLE OR DUPLICATE : 3 9 7 0 2 7 <br /> By.fgnbrg Oft CA ComPIPOWW+TRY 1.09 trd R-04*..CMslgrw�•)requw MA"Womuffim proetded w Orb form wt➢be owalld.nd eerdMwfttt proPrlewy arrd trail."coot to at.wits we»Wr T?tW 14 CCR,a•coon <br /> 1T0414t"tl_D a r"u..t b nr•d.for dbc6o•m•oft"bdamwoo. tM"OW wm .1*"tam rd lila atgraa•and bisptora madras provld•d an Orb farm a mcetpt. <br /> h6 " \C` ,;jtc0, 9 9 n nn8 naw' ara WCL. f I— <br /> Hauler Address 11 <br /> (Truck Decal Number Business Name- <br /> 200 <br /> ame- <br /> ®.aa ® Address WING1000 COMMERCIAL TIRE <br /> City,State and Zip RT S.21'-t AR <br /> 729 <br /> EET <br /> License Plate Number State FORT SNiiTN AR 72901 <br /> aaaa:oo � aa Common <br /> I G.atfy under p—try of perjury­%.,Ore laws o1 Uw State of Califon"that the MKornwW pmMW obore h Vu•and wrr•Ct In wk2kM I em aware mw fahtlkatlon of eft WlIdmwtdon may reach In suspenyon,-sun,or denial of renewal of th <br /> Wast.Tire Haubr Registration Pursuant to Pudic Resarrcea Code section 42860 and rmy result in clyd penab"Lip to$26,00D per duy,Per VlQlatton or sda*vW &,e perm'tba r4 to(6.000 Per vSolation per day as dmdbod in Public Resources <br /> Code <br /> Driver's Name rin Drlverrs ig tura Date <br /> Comprehensive • Log • . Program <br /> 3 9 5 7 0 2 7 -- Pick Up. o delivery o o a a o o a-a o <br /> Hauler Tire Program ID 1 Site Suffix UFaclllty_ <br /> Telephone Number <br /> � DATE .. <br /> . . . L 1 Whole The Count Weight In Lbs. Busineus <br /> Volume Cubic Yda.Q We�ht In Tana_ ddress <br /> Hauler Name .; CKy,State and Zip <br /> v Stamp or Label Ott <br /> Hauler Telephone Number 0 Address Same aH <br /> auler <br /> (N to for 1 CHMWY MT UNDER PEXAL7Y OF PRY OF THE <br /> Whol•Tlrss) UtiMt OF Tim 87ATE OF GALIFORNUI .T1tE <br /> • . • Log Number Load Information Facility Tire Program <br /> -3957027 -- Pick Up•• [A.Delivery. <br /> ® o �oa <br /> � Hamer Tire Program ID 1 Site Suffix _= Facility Telephone Number <br /> DATE D� } D� � EJH <br /> w-® Whole Tire Coujrt a Weight in Lbs. ; <br /> w0c <br /> Volume Cubic Yds. Weight in Tone !'turtl .1•r,'nQrcial Z-je0 <br /> Hauler Name CA 95215 . �• <br /> v L�a HE 'Stamp.or LaW©K, <br /> Hauler.Telephone Number <br /> 0002H■ 'Address Sarre as Hauler � �4 <br /> (N lA fpr' 1 CERTNrY THAT tA1DPJi pE]IAL7Y GF PERJURY OF THE <br /> •�•�4k .. 'WIWla Thio!) U1TS OF 7W eTATN OF GILIFORM Tt1AT T14E {� r•/ - <br /> 1 (f 11 <br /> 3957 0 2 7 -- A ..' Pick Up% Delivery. D © � ® 0 LJ H._ a ' <br /> Hauler Tire Program ID ! Site Suffix ' Facility Telephone Number <br /> DATE <br /> C w ®•WFiole The Count [:]Weight In Lbs.. <br /> o00 ®aao ® a t"Wril <br /> n �. i ST`!® p O V S . <br /> d ❑Volume Cubic Yde.❑Welght In Tons res� <br /> E _ d�� �z Lpi!`E <br /> Hauler Name �{j Y <br /> Stt Ca el OHauler Telephone Numb ' P" NE Address Same as Hau#o <br /> �j �j �JED {N fA far I txJiTMrY TFLtT UM7ER FEiaat.Tv orPEA,NIitY DF tits/ Ot.( r'T1Whd•Tim) ' H8TAT8OF CALIFORf1TF tM A T}¢/ I ✓ f7 to D <br />