Laserfiche WebLink
Toll Free 1-866-896-0600 / www.calrecycle.ca.gov/Tires./ <br /> Dept.of Resources Recycling and Recovery <br /> 0a CA Comprehensive Trip Log and Receipts 10002 P.O.Box 1259,Sacramento,CA 95812-1259 <br /> Com rehensive Tri Number <br /> calRecycle E X A M P L E 1 2 3 4861821 <br /> sm4°"admla IDO NOT TAPE STAPLE OR DUPLICATE <br /> raUfeclde 2M nmol <br /> By igning this NSTRUCTaJONS ON BACK OF PART 2 rdance with Title,14 CCR,Section <br /> CA Comprehensive Trip Log and Receipt,the signerls)request that the information provided on this form will be considered confidential, trad <br /> dential,proprietary and e secret In acco <br /> 11041 et seq.,If a request is made for disclosure of this Information CalRe ycle will contact the signer(s)of this forth at the address and telephone number provided on this form or receipt. <br /> _ V NW—", dle itifor i atforY,, }4` <br /> Hauler Address F Wholesale Equipment of Fresno <br /> Truck Decal Number Business Nanle <br /> aN ® 0 Address dba Wholesale Industrial Parts <br /> City,State and Zip 536 Display Way <br /> License Plate Number State Sacramento, CA 95838 <br /> 9 Common <br /> _i <br /> Carrier � <br /> I cenity under penalty of perjury under the laws of the Stet.of Caldomia tha:tt, Information provided above is true and cored.In addition,I am aware that falsification of this information may result msuspension.revocation,or denial of renewal of <br /> the Waste Tire Hauler Registration pursuant to Public Re—rces Code section 42960 and may result In civil penalties up to$25,000 per day,per violation or administrativeeppe-dies u o 85,000 perviolation per day as descri♦♦/bed in Public Resources <br /> Coda sachon 42962 <br /> Driver's Name Driver's Sign (yCer (J ate tJ (T <br /> • • o Log Numer^^ • ram ID Site Suffix <br /> .. • • • • . <br /> �- 6 8 21 -- V Pick lip Delivery <br /> a 48 1 ❑ L0000 <br /> m <br /> Facility Telephone Number <br /> Hauler Tire Program ID / Site Suffix DATE <br /> cc . aao � oa0000a <br /> UJ Whole T111 Count Weight In Lbs. —_ <br /> tv <br /> — ❑Volume Cubic Yds. Weight in Tons i <br /> E Hauler Name <br /> iawer'Fe!epl,clrf,, Number <br /> s s. <br /> __l Addtc=se: tilt:as Hauler initials <br /> (WA 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 Tr • Log Number Load Information •• 1 <br /> Q <br /> 4861821 -- B Pick Up Delivery <br /> J EM <br /> Facility Telephone NumberHauler Tire Program ID / Site Suffix DATE . � oo� oo G� a � ao <br /> LU Whole Tire Count Weight)n Lbs. —_ <br /> (D D Jf f Volume Cubic Yds. ❑ Weight in Tons <br /> c Hauler Namein <br /> fez ��� PSFf3 <br /> U t✓l^a�cSc�c r- `siv <br /> i 1 Ari+ca;•?'o C=.. '•:..iSsi as Hauler Initials <br /> Hauler Telephone Nurnbnr -- <br /> /f J�7�tt (N/A for I CERTIFY THAT UNDER PENALTY OF PERJURY OF THE <br /> Whole Tires) LAWS OF THE STATE OF CALIFORNIA THAT THE M <br /> 7 ( INFORMATION PROVIDED ABOVE IS TRUE AND CORRECT. <br /> Comprehensive Trip Log Number Load Information Facility Tire Program ID Site Suff ix <br /> v <br /> 4861821 Pick Up Delivery <br /> Hauler Tire Program ID / Site Suffix <br /> Facility Telephone Number <br /> 9 DATE [IE <br /> I—! aao 000000a <br /> m tua Whole Tire Count 0 Weight Iii Lbs, <br /> F] Volume Cubic Yds. Weight in Tons a <br /> O Fi, <br /> cn F- <br /> <'J ..?l.isr 1�Et G _.: Q ® F7 t3ddress..Same aoHauler Initials --- <br /> .1 - I <br /> - I CERTIFY THAT UNDER PENALTY OF PERJURY OF THE <br /> Fa ,I1 (N/A fat - <br />