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Toll Free 1-866-896-0600 / www.calrecycle.c"ov/Tires/ <br /> Dept.of Resources Recycling and Recovery <br /> F"""' <br /> Comprehensive Trip Log and Receipts 10002 P.0.BoK1259,Sacranlento,CA96812-1259 <br /> Com rehensive Tri Number <br /> E x A nn E 1 z 3 4861813 <br /> OFPART2 DONOTTAPE, TAPLEOR DUPLICATETRUCTIONS ON - •_ with Tme,14CCR,Section <br /> By signing this CA Comprehensive Trip Log antl Rec er(s)request that the information provided on this form will be address <br /> to ephonO—Ilden um proprietary and trade secret.In accordance <br /> 17041 el seq.,If a request is made for d,sclosure of ion,CalRecycle will contact the signeds)of this form at the address and telephone number provided on this form or receipt <br /> ;vefiiCld orm Hauler Address �v Wholesale Equipment of Fresno <br /> Truck Decal Number Business Plaine <br /> Address dba Wholesale industrial Farts <br /> o o 0 0 City,State and Zip 536 Display Way <br /> License Plate Number State Sacramento CA 95838 <br /> E000aoo [dH Carried <br /> iJ Carrier <br /> cenity under penaly of perjury under the'aws of tie Slate of Calf.,rua:ha;tle information provided above is true and correct.In acd,ior,I am aware that falsification of this infor-ration may result.n suspension,revocation,or denial of renewal of <br /> the Waste The Hauler Registration pursuant to Pubhc Rescu oes Code section 42960 and may result in cvii penalties up to$25.000 per day,per vioianon or adminlst tive penal ies uo to$5,000 per violation per day as describPublic Resoed h urces <br /> Code section 42962 <br /> L/ A: <br /> Driver's Name(print) Driver's S' ature Date <br /> Comprehensive Trip .. Number Load Information Facility Tire Program <br /> -- Delivery <br /> S <br /> Facility Telephone Number <br /> U <br /> 0 Hauler Tire Program ID / Site Suffix DATE /• / a <br /> i000 000000 <br /> a Whole Tire Count Weight n Lbs. <br /> CL <br /> Volume Cubic Yds. ® Weight in Tons <br /> E Hauler Narne <br /> : 15 <br /> U Q <br /> i�....J AGtIi ll:::;r.� I':ii i..'s t'1 Initials <br /> Hauler Telephono NL!r—rbi (elle for I CERTIFY THAT UNDER PENALTY OF PERJURY OF THE <br /> Whole Tres) LAWS OF THE STATE OF CALIFORNIA THAT THE <br /> INFORMATION PROVIDED ABOVE IS TRUE AND CORRECT. <br /> d Information Facility Tire Program ID Site Suffix <br /> 4 8 61813 -- B Pick Up Delivery <br /> fz 0000� o <br /> m Facility Telephone Number <br /> o0 00 00 <br /> Hauler Tire Program ID / Site Suffix DATE <br /> y . . aoo� �-000e [�—JI <br /> LU ['Whole Tire Count Weight to lbs. <br /> / Y ?-Ih ® v E] Volume cubic Yds. ❑ Weight in Tons <br /> r <br /> E Hauler Name <br /> (' "� �' 3sy <br /> 7 /✓hdfir � <br /> E000EV00 <br /> -G t� C eU ¢ - ; ti.r3L"ices:;:zzrtTP as Hauler Initials <br /> Hauler Telephone iSiuInbc-1 -- <br /> (N/A for I CERTIFY THAT UNDER PENALTY OF PERJURY OF THE <br /> Whole Tres) LAWS OF THE STATE OF CALIFORNIA THAT THE <br /> INFORMATION PROVIOEDABOVE IS TRUE AND CORRECT. <br /> Comprehensive Trip Log Number Load Information Facility Tire Program ID Site Suffix <br /> ' 1 <br /> 4861813 -- A <br /> = Hauler Tire Program ID ! Site Suffix n� <br /> Facility Telephone Number <br /> iDJt►TE _�� �;oo <br /> -_, w yifhole 1'Ire Crsurrt �1Neight m Lbs..- <br /> non �. 0000000 <br /> �,. - - � - � �Volum�CUbt[�X(ds �.1Ne►gbtiit)T�nls <br /> Ips . <br /> q Hauler Name <br /> s-r r..t .-,tiu �.. <br /> Addre� Sa e at` H tiler InNlals <br /> --mitntUl ''S 1 CERTIFY THAT UNDER PENALTY OF PERJURY OF THE <br />