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Callfomla Integrated Waste Management Board <br /> CA Comprehensive Trip Log and Receipts 10602 o.Box 1259,Sacramento,CA95812-1259 <br /> 10XIAIMIPILIE[' 1112131 Comprehensive Trip Number <br /> awe33(114 INSTRUCTIONS ON BACK OF PART 2 DO NOT TAPE,STAPLE OR DUPLICATE <br /> 3249642 i <br /> By algning MIs CA Comonhan.N.Trlp Lop and R..IpL IM signer(.)rlauee4 that INa Inlormad. proYdld m MIF rum,W a sanald—d ooMNIN.0.l,pfa ..ry and bitl!alcraL In aced d...0 not,I{CCR.S..uu. <br /> 17W1 et It",NareRue.l Vmada la W.I.—of WF Ills HdAuL Me CnVNIB WII--A.elgnerl.)at MIF farm a1 Ma addnae and W.pNona-W, on MIF lean w ocelot <br /> Veh I c I MI I RUFF—at ton Hauler Address � t 1— r, 1 <br /> Truck Decal Number (Y�/�� /y7 l(F <br /> Business Name vv G Uc ,ter G O j97110L,2 <br /> — ® © Address (?.0 . (:�0y )"107 J <br /> City,State and Zip <br /> License Plate Number State <br /> © o Carr .Common <br /> ier . L� <br /> I C1My and,penally a pmlu y uWw Me lace a ft$I.W M CNIdonW Mal Uro INormaWn;ms Wore Is true r.d oarta 4.I r addNbn.I un.vnra wt r`Z"uon of uva Wamadon may Issue in wsan4a^.ra—ton,ur dMw a R- <br /> .1 0, <br /> wast Tke Hwkr RegiFpelWn pun--I W Pudic Re­Code secden.2960 and may reFua m WN penaNes up W S 25,OWW dry.par v IaLan M edmlNelnpve pa-W.tW W$'.0 par wut a pm day..das d in F.k Rmdvpe. <br /> Lode FaCepn 1 2 <br /> Driver's Name(print) Dover's Signature Date <br /> Comprehensive Trip Log Number Load Information Facility Tire Program ID Site Suffix <br /> 3249642 .. -- C. Up a Delivery <br /> Hauler Tire Program ID I Site'Suffix Facility Telephone Number <br /> DATEae � aa � oo _ <br /> LuuJ a Whole Tire Count Weight in Lbs. ® a a 1JHNDEHB <br /> Faf��I1' L�inesS <br /> `g <br /> 1101 31-,13 Q �,a Volume Cubic Yds.❑Weight in Tons Nembl�d&less(` { <br /> City3oom� fC/l�•c p <br /> E <br /> UHauler Name p� <br /> (J �---• .�7 a �aaaa Stampprd'' `�'� /4' J <br /> Hauler Telephone Number. ■ Address Same as Hauler. mRlara <br /> /J /► .f- `� (N!A for 1 CERTIFY THAT UNDER PENALTY OF PERJURY OF THE <br /> Whole Thea) UW9 OF THE STATE OF CALIFORNIA THAT THE Y)/L^ <br /> INFORMATION PRO <br /> NDED ABOVE IS TRUE AND CORRECT. �/ <br /> Comprehensive a 1e NumberFInformationea <br /> i. Z3249642 - -= B P-Piqk Up Delivery .aN N d N [4 - <br /> Of Hauler Tire Program ID / Site Suffix FacilityTelephone Number <br /> DATE <br /> JT C _H <br /> � ICOrWhole Tire Count E]Weight in Lbs. H HHE ED N <br /> f Fagility Q�iness, <br /> m I 3 3 :• O Z a.Volume Cubic Yds,❑Weight In Tons p e A �s� ('7CF 1�Qt <br /> E Haauu'ler.Name: <br /> Stamp <br /> E00OPMENHauler Telephone-Number. 0 Address Same as Hauler lnlN,l, ; <br /> (N IA for I CERTIFY THAT UNDER PENALTY Of PERJURY OF THE' <br /> Whole TI..) LAWS OF THE STATE OF CAuiORNIA THAT THE <br /> HIFORNATION PROVIDED ABOVE 19 TRUE AMD CORKER. T <br /> Comprehensive Trip Log Number Load Information <br /> . 3249642 . -- /� . Pickup a Delivery E �� a HH 5 H-� <br /> d Hauler Tire Program ID I .Site Suffix DATE Q 3 d �j Facility Telephone Number <br /> o0 oa as o _ S 3 � �� � �, •� <br /> _ �a© oaoaa ®a <br /> �. -®Whole Tire Count. El Weight In Lbs. FFM q <br /> 1 1e�f�t/r ceS <br /> Volume Cubic Yds.❑Weight In Tons Address <br /> E Hauler Name C�? t �a .CI^t f sr`^C r-. An <br /> a 8tarrT dress Same <br /> a 6?4-�011 <br /> Hauler Telephone Number ■ Address Same as Hauler !nalala , <br /> / 7 (N!A for I CERTIFY THAT UNDER PENALTY OF PER"U" <br /> E THE <br /> 7/ WNole nrea) UWS OF THE STATE OF CWFO15 T THAT THE <br /> INFORMATION PROVIDED ABOVE IS TRUE ANO CORKER. <br />