Laserfiche WebLink
Toll Free •1-866-89660600 / www.calrecyclt.-.ca.gov/Tires/ <br /> Dept,of Resources Recycling and Recovery <br /> CA Comprehensive Trip Log and Receipts 10002 P.O.Boz 1259,Sacramento,CA 95812-1259 <br /> CalReCyCle x a M P:EEj 111213 ° M0= = Comprehensive�a}Tri Number <br /> cwyelezarpifo/INSTRUCTIONS ON BACK OF PART 2 DO NOT TAPE, STAPLE OR DUPLICATE 4861 O 6 <br /> By signing this CA Comprehensive Trip Log and Receipt,the signer(s)request that the information provided on this form will be considered confidential,proprietary and trade secret.In accordance with Trtie,14 CCR,Section <br /> Y7041 et seq.,If a request is m.de for disclosure of thrj information,CalRecyele will contact the signer(s)of this form at the address and telephone number provided on this form or receipt <br /> } Vehicle 1106f nation <br /> Truck Decal r urni�er Mauler Address i Wholesale Equipment Of Fresno <br /> 13uSirieSs N2�e , <br /> Address dba Wholesale Industrial Parts <br /> License Plate Number State <br /> Ci :1: State and Z"in 536 Display Way' <br /> NA11M-Mon Sacramento, CA 95636 <br /> �-� Carrier <br /> I certify under penalty of perjury under the laws of the Stale of Calilorria that the information provided above is true and cocact.In addition,I am aware that falsification of this information may result in suspension,revocation,or denial of mnawal of <br /> the Waste Tine Hauler Regi pursuant to Public Resources Code Section 42960 and may result in civil penalties up to S 25.000 per day,per violation or acimi' ralive penalties up to 55,000 per violation per day as described in Public Resources <br /> Code section 42962 1 <br /> If <br /> Driver's Name(priH Driver's ignature Da e <br /> ' 8 61816 �a� F1 ,Ck up Delivery <br /> oao � o � oLILJ <br /> m, Hauler Tire Program ID / Sites uffix n nn Facility Telephone Number <br /> P <br /> -A DATE <br /> Whole"tire Count Weight ht in Lbs. � � � + � � � � t i <br /> W � o <br /> ® r Volume Cubic Yds. Weight in Tons + <br /> C, Hauler Name <br /> D.Hauler Telephone- BE -arne as Hauler <br /> If sir=rs <br /> 0,VA for I CERTIFY THAT UNDER PENALTY OF PERJURY OF THE <br /> Whoie Tims) I AWS OF THE STATE OF CALIFORNIA THAT THE <br /> INFORMATION PROVIDED ABOVE IS TRUE AND CORRECT. <br /> CEJ <br /> Q ` 6 8r] Pick Up Delivery <br /> a <br /> .r <br /> I�n <br /> l. <br /> Q) Hauler Tire P ;gram ID / Site Suffix l Facility Telephone Number <br /> i�ATEoil z z <br /> a Whale TT otant Weight in Lbs. <br /> ® oo� ( � 0000 <br /> ( 7 j ® o 1/, E] Volume Cubic Yds. ❑Weight in Tons <br /> E Hauler Nart;;a <br /> n fry e4 L S—P-i- <br /> Hauler Telf-al_:s'-one N,.i: j i Address rami ` <br /> e as Haul_. -- <br /> ����� � initials <br /> (N/A for I CERTIFY THAT UNDER PENALTY OF PERJURY OF THE <br /> f('��� •.! ��`) �L J` ltd Whole Tires) LAWS OF THE STATE OF CALIFORNIA THAT THE <br /> INFORMATION PROVIDED ABOVE IS TRUE AND CORRECT. <br /> { <br /> 4861816 ®— A `Pi,b ®silvery 0 0 <br /> .17 <br /> oao- a <br /> Hauler Tire Program ID / Site Suffix FaClhty Telephone Number <br /> umber <br /> to - <br /> tA; `a 0 Whole Tire C,ounf' � lNeight in Lps. <br /> oac� a0000 <br /> Volume Cubic Yds. Weight in Tons <br /> in } <br /> .: moi" 'at'7:"2 - LJ � - {.Ei-{'.•t'i`J w"1. a5c$i2`u�fT.:Jl.liF:� <br /> initials <br />