Laserfiche WebLink
Toll Free 1-866-896-0600 / www.cair6cycle.,,,a.gov/Tires/ <br /> Dept.of Resources Recycling and Recovery <br /> 10002 P.O.Box 1258,Sacramento,CA 95812-1 259 <br /> CA Col �,prehensive Trip Log and Receipts Comprehensive Trip Number <br /> CelRecyCle E X P L E 1 2 3 52242 <br /> 8 0 <br /> Strfeei'XD m2 INSTRUCTIONS ON BACK OF PART 2 DO NOT TAPE STAPLE OR DUPLICATE i __ _ e <br /> CaWeeydelg3 p/ifq d van secret 1 w�urda wah nue f CCR,. <br /> Sy signing this CA Comprehensive rip Log and Receipt,the signarls)request that the information provided on this form will be considered confidential,proprietary an <br /> 17041 et seq.,If a request is made for disclosure of this information,"Recycle will contact the signertj of this farm at the address and telephone number provided on this form or receipt. <br /> oletrofoiamation Hauler Address <br /> TuckDeca Numtrer R11 iness FlalTle Wholesale Equipment of Fresno <br /> Address _ dba Wholesale Industrial Parts <br /> City,State and Zip �2 �la� <br /> License FlateNumber State <br /> 536 Display Way <br /> 1 � 1 f ENT <br /> Common __ Sacramento, CA 95838 <br /> 0-1 carrier <br /> of <br /> I certlly under penalty of penury under the laws of the State of Caldomia that the Information provided above is true and correct.in addition,I am aware that falsification of this information may result in suspension, y as described <br /> or denial of renewalr <br /> the Wzste der Hauler Registration pursuant to Public Resources Code section 42960 amtl may result in civil penaNizs up to S 25,000 pe7-Im— <br /> lati-an orad mistrdtive penalties up to$5.000 per violation per day as des/rnbatl+n Public Resources <br /> Tir <br /> Code section 42962 mf- �"d l <br /> �%� _ — Date <br /> Driver's Name( int) QriGernature <br /> i <br /> Q 52270 - <br /> ` �' El <br /> Pick Up Delivery <br /> v Facility Telephone Number <br /> it Hauler Tire Program ID / Site Suffix i EEI?AT,E E� 0M. <br /> a <br /> in <br /> ao� 000aoao <br /> U.1 whole Tire count [ Weight In Lbs._ <br /> CL <br /> (� `� I— Volume Cubic Yds. 11 Weight Tons �� �j��lt- <br /> � <br /> G <br /> Hauler[3atTle `'� <br /> o fir_ <br /> fir <br /> dre-ss Sal-Plc- 3 I'{1uj Initials <br /> i'2aiJler �`v414.'431' <br /> (N/A mr I CERTIFY THAT UNDER PENALTY OF PERJURY OF THE <br /> `-� %�.�..C; <br /> Whole T� ::i LAWS OF THE STATE OF CALIFORNIATHAT THE <br /> (( C( ]J INFORMATION PROVIDED ABOVE IS TRUE .....ECT. ___�,•,,,_ <br /> hity Tire Progmm ID IX <br /> um er ad 1rlifdrmation::: 81011 <br /> —0ompre-he-hisiv w, 0 F1 <br /> Pick Up l]iliery - r. <br /> _ ooaaoaaoo <br /> a Hauler Tire Program ID / Site Suffix Facility Telephone Number <br /> DATE Of <br /> lsYiu1e Tire Coun4" Wei ht in Lbs. a u <br /> GC ._ ❑ 9 <br /> ❑ Volume cubic YdS ❑ Welght>n,Tons c i <br /> Hauler IVan-le .'_�.: ' •�.r�:� �; -: �r4:`�� I <br /> HF <br /> 4— C< <br /> F <br /> a_ <br /> Hauler Iefelohrin£ ® ✓ 3_tt.�rrc S.,v.:,a ie as lliauie, Initials .�• <br /> CERTIFY THAT UNDER PENALTY OF PERJURY OF THE <br /> Whole Tires LAWSOFTHESTATE OF CALIFORNIA THAT THE <br /> _- - �- INFORMATION PROVIDED ABOVE IS TRUE AND CORRECT. <br /> Load Information FaCilitY Tire Program ID Site Suffix <br /> 5224280 �l-SIMM — <br /> _ � �_ �_ « oaa000aoo <br /> s�. Facility Telephone Number <br /> �*? Hauler Tire Program ID / Site Suffix ty P <br /> DATE <br /> _ aoa� ooaaaoo <br /> a ❑`,Whole Tire Count Weight in Lbs. _ <br /> r I— Volume Cubic Yd5� Weight in Tons <br /> Hauler Name � [ITE <br /> y _ <br /> DE <br /> _ t 'd LII-6t Te12�hoii� t 1r ..:� _a - to "iv.�`sct._... - S-1$tFIHi„ .-. <br /> �• - _ Initial: <br /> i,.<__ Ir.crx$1-—T unco osunrrnr opo ii,wne rue <br />