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Toll Free 1-866-896-0600 / www.calrecycle.ca.gov/Tires/ <br /> Dept.of Resources Recycling and Recovery <br /> CA Comprehensive Trip Log and Receipts 10002 P.O.Box 1259,Sacramento,CA 95812-1259 <br /> Comprehensive Trip Number <br /> CalRecyde E X ' M P L E 1 2 3 _ 5224285 C <br /> caae�rfec2am�ngl INSTRUCTIONS ON BACK OF PART 2 DO NOT TAPE,STAPLE OR DUPLICATE I ,5 Z Z 2 5 <br /> By signing this CA Comprehensive Trip Log and Receipt,the signer(s)request that the information provided on this term will be considered confidential,proprietary and trade secret In accordance with Title,to CCR,Section <br /> %tjjOM1t <br /> at seq.,if a request is made for disclosure of this information,CalRecycte MR contact the signers)of this form at the address and telephone number provided on this form or receipt. <br /> % .. ehia-Ce Iriformatlon r-- <br /> Truck Decal Number Hauler Ac-til S ' Wholesale Equipment of Fresno <br /> Rusines.TNam.e <br /> Address° dba Wholesale Industrial Parts <br /> State ntl z_i,_, 536 Display Way <br /> License Plate Number State <br /> I, rri <br /> ° e°" ?._ _ Sacramento, DA 95838 <br /> eeJt dy under penalty of penury under the Fav, of the State of Calirorrla that the information orovioed above is true and oomeot.In aodlf— am aware that talslfidati of'.nlormation may resun n suspension.re-dat on,or denial of re.-ewal of <br /> the yJas-.e Tire Hauler Registraton pursuant io PIld is Resour Code section 42960 and may result in civil penalties up to S 25.000 per day,per violation or administatenalties up to$5.000 per violation per day as desc71- <br /> �n Pt io Resources <br /> Code sectlon 42962 �• <br /> .� 7 /� <br /> Driver's Name(print) Driver's Signature Date <br /> Comprehensive Trip Log Number Load Information Facility Tire Program ID Site Suff ix <br /> Q 5224285 -- C Pick Up Delivery <br /> CD <br /> M: DATE I I� / 11 E Facility Telephone Number <br /> Hauler Tire Program ID Site Suffix L� <br /> V <br /> aao� a0000ao <br /> CU LU Whole Tire Count, El Weight irr Lbs. _. <br /> ~ Volume CubicYdsc.[:]Weight in Tons <br /> E i-lai i=r Nanls <br /> a <br /> c3 � Q <br /> auI r late ':;,I p i Initials <br /> INiA for I CERTIFY THAT UNDER PLNALTY OF PERJURY OF THE <br /> Whole Trasi LAWS OF THE STATE OF CALIFORNIA THAT THE <br /> INFORMATION PROVIDED ABOVE IS TRUE AND CORRECT. <br /> oil <br /> Comprehensive Trip Log Number Load Information Facility Tire Program ID site Suffix <br /> 5224285 __ B Pick up Delivery <br /> �lJ �� • , � Facility Telephone Number <br /> Hauler Tire Program ID / Sitet;Suffix DATE <br /> M, Ec ERE <br /> � a Whole Tire Count ❑Weight.in Ws. ___ �+3 <br /> �' 3 ®. 0 Volume Cubic Yds. Weight in Tans-. r <br /> Eat <br /> Initials <br /> _ .[N/A for I CERTIFY THAT UNDER PENALTY OF PERJURY OF THE <br /> ey7 r a r�- Whole Tires) LAWS OF E STATE OF CALIFORNIA THAT THE <br /> LAWS <br /> PROVIDED ABOVE IS TRUE AND CORRECT. <br /> Suffix <br /> _a <br /> ComprehensiveiWip •• Number <br /> •� • .•__ • Tire <br /> a a - Program a ta a-- <br /> a a <br /> 5224285 PiptU � p�ll�er� <br /> Hauler Tire Program ID / Site Suffix Facility Telephone Number <br /> 00 <br /> 4. <br /> ti . . . 000 � a000aoa <br /> �. Whole Fire Coohf Q U1/eight trt Lbs.: _ <br /> L: Volume DuiHc YHs tiVefght <br /> #. <br /> rJGYe me ss Same as Hauler -- <br /> Initials <br /> I CERTIFY THAT UNDER PENALTY OF PERJURY OF THEre <br /> - <br />