Laserfiche WebLink
T(Al Free 1-866-896-O6iYd--iwww.cairecycie.ca.gov/Tires/ <br /> very <br /> CA Comprehensive Trip Log and Reeeipts <br /> Dept.of 1259'ResoSacramentces o. <br /> Recycling 991nd 2 125 <br /> '{QOQ`2 P.O.Box 1259,Sacramento,CA 95812-1259 <br /> CalRee cle E X A M P L E 1 2 3 = Comprehensive Tri Number <br /> y 5224275 , <br /> State(* Irlomra <br /> capra�laezal�ng)INSTRUCTIONS ON BACK OF PART 2 DO NOT TAPE STAPLE OR DUPLICATE <br /> By signing this CA Comprehensive Trip Log and Receipt,the sigrer(si request that the information provided on this form will be considered confidential,proprietary and trade sacrat In accordance with Title,14 CCR,Section <br /> 17041 at seq.,If a request is made for disclosure of this information,CalRecycle will contact the signers)of this form at the address and telephone number provided on this toren or recelpl. <br /> Truk Decal Number ;hauler Address Wholesale Equipment of Fresno <br /> Business Name <br /> Address dba Wholesale Industrial Parts <br /> late Number Sate City, stat` ,Zip 536 Display Way <br /> L� <br /> Z 'LJ � Q � � Q� � •::�,,,.�r _..._ Sacramento, CA 95838 _ <br /> —' Carrier <br /> l carry undar penalty of pe-'iury under it,,la—of the State of California f hat the intonation provided above Is true and correct.In addition,I am aware that falsification of tis information may resuh in suspension,revocation,or danlal of rani—al of <br /> the Waste Tire Hauer Fegslrat:nr.pursuari;ti,Publ,c Resowces Code sect,.,42960 and may result in crud 0—ft—up to S 25,000 per day,per violation or administrative ,aides up to 55,000 per violatipn par day as described in Public Resources <br /> Code section 42962 1 <br /> ez <br /> tet( <br /> Driver's Name(print) Driver's Si ure Date <br /> Comprehensive Triqj-og <br /> Load <br /> Facility Tire Program ID Site Suffix <br /> •iu <br /> 5224275 -- C Q Pick Up Delivery <br /> a Facility Telephone Number <br /> � Hauler Tire Prograr�.ID / Site Suffix <br /> � DATE <br /> N oaa ooa000a <br /> wa Whole Tire Count :Weight in Llis. _ <br /> •— ~ Volume Cubic Yds. Weight in.Tons <br /> -.o <br /> l <br /> i'irt tier - - ^ • - -. - - Initials <br /> (NIA for I CERTIFY THAT UNDER PENALTY OF PERJURY OF TI4E <br /> - - Whole Tires) LAWS OF THE STATE OF CALIFORNIA THAT THE <br /> INFORMATION PROVIDED ABOVE IS TRUE AND CORRECT. <br /> CoMprehensive Trip Log Number Load matiot, Facility TireFrogram ID Site Suffix <br /> 5 2 2 4 2 7 5 -- Pick Up Delivery <br /> .� <br /> I�( E Facility Telephone Number <br /> Hauler Tire Program ID / Site Suffix DATE L'_f <br /> R wa W Who{e Tire Count [j Weight in Lbs-- <br /> 41 <br /> aoo � 000aaoo <br /> D Volume Cubic Yds. Weight in Tons <br /> E <br /> -f31 <br /> V <br /> Initials <br /> j \/ - (NJA forI CERTIFY THAT UNDER PENALTY OF PERJURY OF THE /'t <br /> Whole Tire.) LAWS OF THE STATE OF CALIFORNIA THAT THEF <br /> INFORMATION PROVIDED TRUE AND CORRECT. <br /> ABOVE IS <br /> Comprehensive Trip Log Number <br /> Facility Tire Program ID Site Suff ix <br /> 5 2 2 4 2 7 5 -- /4. P �> �eE>EY <br /> m` Facility Telephone Number <br /> Hauler Tire Program ID / Site Suffix <br /> DATE <br /> OUT <br /> LlWho{e TireGaunt -Weight <br /> ,� ® Volume Cabin Yds 1Net ght m Tans <br /> F <br /> .{fir£'zs •',amu r.s {-!o,..�.. Initials ---- <br /> I CERTIFY THAT UNDER PENALTY OF PERJURY OF THE <br />