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Toll Free 1-866-896-0600 / www.calrecycle.ca.gov/Tires/ <br /> Y Dept.of Resources Recycling and Recovery <br /> CA Comprehensive Trip Log and Receipts 10002 P.O.Box 1259,Sacramento,CA 95812-1259 <br /> E X A M P L E 1 2 3 Com rehensive Tri Number <br /> Cal Recycle 4 86180 <br /> 6 <br /> Sof f Cy—a, <br /> Ca1R 203(7/IujINSTRUCTIONS ON BACK OF PART 2 D TAPE STAPLE OR DUPLICATE <br /> going this CA Comprehensive Trip Log and Receipt,the signer(s)request that the irr onnath, vided on this form will be considered confidential,proprietary and trade secret In accordance with This,14 CCR,Section <br /> 17041 et seq..N a request is made for disclosure of this information,CaiRecycle will contact the signers)of this form at the address and telephone number provided on this form or receipt. <br /> I <br /> Truck Decal Number Hauler Address j Wholesale Equipment of Fresno <br /> I�usiness Namedba Wholesale Industrial Parts <br /> � � rSta <br /> City, `.�`3tn and dip 536 Display Way <br /> License Plate Number State <br /> �� I,c Sacramento, CA 95838 <br /> I ceriity,under penalty of perjury under tre fans of the State of California that u� ,{ap+atlon prodded above is true and ccr*ect.In addition,I an,aware that falsification of this information may result in suspension,revocation,or dada of ran—al of <br /> the Waste Tire Hauler Reg rater pu,suant tc Pubnc Resources Code section fi0 and may resuh in civil penahles LIP to S 25.000 per day,per violation or admin'sr ative enahies up to 55.000 net violation per day as described in Rublic Resources <br /> Code section 42962 �-f/��Cr' /),z <br /> ,����� <br /> Driver's Name(print) Driver's Si tura Date <br /> Comprehensive Trip . . Number Load Information Facility Tire.Program <br /> a 4 8 618 0 6 -- C Pick Up u Delivery o 0 0 0 o aCU <br /> L] <br /> Facility Telephone Number <br /> Hauler Tire Program ID / Site Suffix DATE <br /> C utEl Whole [][] <br /> 1„ Count F] Weight in Lbs.L� 000 � aooaaoa <br /> a : <br /> Volum: ."ic Yds. ❑ Weight in Tons <br /> pHauler Name <br /> 4.. <br /> y � <br /> .. i <br /> Hauler Telephone int+l-.1'•�-'•r ■ Address em' Ott'.as HaL,f::`r- /nnials --- <br /> (N/A for I CERTIFY THAT UNDER PENALTY OF PERJURY OF THE <br /> Whole Tires) LAWS OF THE STATE OF CALIFORNIA THAT THE <br /> INFORMATION PROVIDED ABOVE IS TRUE AND CORRECT, <br /> Comprehensive Trip Log Number Load Information Facility Tire Program ID Site Suff <br /> 4 8 618 0 6 �' � Pick Up Delivery <br /> .� u <br /> a� ®� Facility Telephone Number <br /> Hauler Tire Program ID / Site Suffix u J�J <br /> c w s <br /> CL DATE <br /> Whole Trre Count Weight in Lb . _ <br /> C i 1�s� <br /> Volume Cubic Yds. ❑ Weight in Tons <br /> pH/aJu/Eer PJ am/e �1 L� C- <br /> U LtJ G(,laos 4l� G'(- Z'b�1 01 <br /> EmEo <br /> Q iddi'e-.- -"3zarne a5 Hauler <br /> Hailer Teleohiae Initials -.. <br /> (N/A for I CERTIFY THAT UNDER PENALTY OF PERJURY OF THE <br /> ,���r � � Whole TIre51 LAWS OF THE$TATE OF CALIFORNIA THAT THE <br /> INFORMATION PROVIDEp A90VFs <br /> IS Trr AND CORRECT <br /> Comprehensive Trip Log Number Load Information Facility Tire.Program ID Site Suffix <br /> 48 &1806 -- A pit UP ©el�very E11 U 0 E E <br /> - 0 <br /> Hauler Tire Program ID / Site Suffix r "" Facility Telephone Number <br /> Sao ooaaaaa <br /> � a �>Who(eTireCOurit:, Wefghtm<L�s <br /> f � <br /> -�, VOlume Cubtc Yds [ :Weight ut <br /> I <br /> V ®ri.Y cl�,(,iit�f.,. i-.,_ a .- F : � .: -- I i,'-�+-cress ;7ctr`-�ce. as Hauler Initials --- <br /> I CERTIFY THAT UNDER PENALTY OF PERJURY OF THE <br />