Laserfiche WebLink
Toll Free 1-866-896---6-660 / www.calrecycle.ca.gov/Tires/ <br /> DepL of Resources Recycling and Recovery <br /> i02 CA Comprehensive Trip Log and Receipts 10002 P.D.Box 1259,Sacramento,CA 95812-1259 <br /> Comprehensive Trip Number <br /> calRecycle E X A M P L E 1 2 3 i 5224293 <br /> 5 °' '° INSTRUCTIONS ON BACK OF PART 2 DO NOT TAPE STAPLE OR DUPLICATE' <br /> eB203 nr0) <br /> Byy signing this CA Comprehensive hip 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 et seq.,If a request is made for disclosure of this infonnati—,CalRecycle will contact the signerisl of this form at the address and telephone number provided on this fern or receipt. - <br /> _. letifbi&1"nition . <br /> Hauler Address <br /> Truck Decal Number Business Narne Wholesale Equipment of Fresno <br /> j 11 Address dba Wholesale Industrial Parts <br /> i L�J LJ City, :Mate and:Zip ��1 <br /> License Plate Number State-- 536 Display Way <br /> Sacramento, CA 95838 <br /> u ►� Carrier �-- <br /> of <br /> I eerily under penalty of Perjury under the laws cif the State of Galltornia That the Information provided at»ve is true and correct In addition, am aware that falsification th's information may 0 per <br /> In suspanper revocation or denial Public <br /> renewal,c <br /> the Waste Tire Hauler Registration pursuant In Public Resources Code section 42960 and may—in in civil penalties up to$25.000 per day,per violation o ministr I e penalties up to$5.000 per violation per day as tlescnbetl in Public Resou�cas <br /> Cade section 42962 <br /> C�� I <br /> Driver's Name(pri <br /> Driver's gnature Da <br /> Site Suff ix <br /> .. . Program <br /> Comprehensive Trip Log qumber <br /> 522429 <br /> 3 __ C Pick Up Delivery <br /> v <br /> Facility Telephone Number <br /> d) Hauler Tire Program ID / Site Suffix DATE <br /> o� 0000000 <br /> a o-whole Tire Co rit,".[j)Netght in Lbs. <br /> ® o Vofulne'Gubtc1ds. WPooreight in TonsE 0:E ' <br /> tv - <br /> +) ED7 <br /> I CERTIFY THAT UNDER PENALTY OF PERJURY OF THE <br /> itifor, - <br /> Whole Tf�S!t (AWS OF THE STATE OF CALIFORNIA THAT THE <br /> INFORMATION PROVIDED ABOVE IS TRUE AND CORRECT <br /> • • • •- • • • <br /> w <br /> 5272421,313 -- Picts Up Delivery �— <br /> Q <br /> Facility Telephone Number <br /> U <br /> 0 gram ID / Site Suffix DATE i <br /> PUN <br /> � o �oo �ao <br /> LU Whole Tire count ❑Weight in Lbs. <br /> o0 <br /> > El Volume Cubic l(ds. 1Nei6ht itt Tans. <br /> 3 El <br /> N0161 t—0 DOE E I <br /> Q i;:as fri>vuki Initi <br /> tr <br /> Cy <br /> (N!A 1cr I CERTIFY THAT UNDER PENALTY OF PERJURY OF THE <br /> G u� whole Tires) LAWS OF THE STATE OF CALIFORNIA THAT THE <br /> NFORMAnON PROVIDED ABOVE IS TRUE AND CORRECT. <br /> • • hensive 111... • • • Number • • InformationProgramSite Suff <br /> 5224293 -peinrer�r' <br /> r __._ 00000 <br /> =' Hauler Tire Program ID / Site Suffix Facility Telephone Number <br /> _ttATE_ ' <br /> _ _ Enorya000000 <br /> to ,�:Whol"e Tire Count �-31l�eightlrtlbs. , <br /> � I � - � li � I I - � ��iolume Cub►c'�flts �jW�ghi:,n Tc�� <br /> o, Hauler Fame <br /> :a.•d,zcs, Sarre as gpI tiler <br /> In 15 <br /> Milli (CERTIFY THAT UNDER PENALTY OF PERJURY OF THE <br />