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Toll Free i jNAR -0606�%www.Calr�cycl� �.govlTiresl <br /> R Dept.of Resources Recycling and Recovery <br /> �CA Compreh sive Trip Loi and Receipts 10002- P.O.Box1259,Sacramento,CA95812-1259 <br /> j E 12 3 <br /> Comprehensive Tri Number <br /> CMfleCVC1eEXAMP L <br /> Cn1RwWeMpil0)INSTRUCTIONS ON BACK OF PART 2 DO NOT TAPE,STAPLE OR DUPLICATE �4 8 6.18 . <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 Title,14 CCR,Section <br /> 17041 at saq.,H a request Is made for disclosure of this information,CalRecycle will contact the signers)of this tore at the address and telephone number provided on this form or receipt. <br /> �v, .:.;;. ,ir+eticl slhfiirmatlon.�:.�'� ,,-- <br /> Trjrk Decal Number Hauler Address # Wholesale Equip gent of Fresno <br /> Lousiness N?n�a <br /> p <br /> Address dba Wholesale Industrial Parts <br /> Gid,state and Zip 535 Display Nay <br /> License Plate Number State' <br /> 0 Comm, Sacramento, CA 95838 <br /> ]iiE I L— Carrieron L <br /> I cert iiy—uer penalty of perjury under the laws of the State of Caidoroia that the irformanon provided above is true and coned.In addition,I am aware that falsification of this Information may result.n suspension,revocation,or de—I of renewal of <br /> the waste Tire Hauler Registration pursuant to Public Resources Gode section 42960 and may result in civil penafties up to S 25,000 per day,per violation or administrative penalties up to 45,000 per violation per day as described in Public Resources <br /> code section 42962 ) <br /> Driver's Name(pri ) Driver' ignature Date <br /> 4. 8 618 2 4 Pick up Delivery <br /> i <br /> g <br /> cc- Hauler Tire Program ID / Site Suffix Facility Telephone Number <br /> QAT-- hNu <br /> n� -� i <br /> Lu Wilole Tire Count Weight in Lbs: <br /> y Volume Cubic Yds Weight in Tons <br /> E Hauler Name <br /> mauler Telephone N s_4 s_W- � � Address Sat 7e as Hauler Initials <br /> (1,1/A for I CERTIFY THAT UNDER PENALTY OF PERJURY OF THE <br /> Yfnole Tires) LAWS OF THE STATE OF CALIFORNIA THAT THE <br /> e' INFORAIATION PROVIDED ABOVF IS TRUE AND CORRECT. <br /> Q <br /> 4861824 Pick Up Program Suffix a,t1elivety Facility® �Telephone <br /> Num <br /> Hauler Tire PID / Site Six Telne Number <br /> DATE � aa 5 . <br /> LU(e Whole Tire Count Weight i bs. <br /> apo 000ao � �� <br /> D IQ 7 13 I j' ® ' Volume Cubic Yds. Weight in ons <br /> E Hauler NamY X56. <br /> a <br /> Hauler Telephone Nurnise; l e � ; Addl o}s Same as Hawer <br /> Initials <br /> (MIA for.. I CERTIFY THAT UNDER PENALTY OF PERJURY OF THE <br /> 1 916) �(1 `S�(: Whole Tires)�r LAWS OF THE STATE OF CALIFORNIA THAT THE <br /> - INFORMATION PROVIDED ABOVE IS TRUE AND CORRECT. <br /> 4 <br /> 861824 "'tea 'Pl�k Ir'� = 3eliveoy L�Jm t <br /> v. Hauler Tire Program lb / Site Suffix Facility Telephone Number <br /> DATE El <br /> mLu, �.Whole Tire Count We?gtit in L6S <br /> aoa�taoo <br /> El Volume Cubic Yds. Weight if)Tons <br /> o Hauler t;Ea)nn '. <br /> ';.pier rel t. t.t`fe Nkoe A;F4 Address`;an—r ,cts HaLlier fnitlals <br /> - -_. '.(iJlA fOr _ I CERTIFY THAT UNDER PENALTY OF PERJURY OF THE r <br />