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Toll Free 1-u66-8960600 / www.caIrecycle..-a.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 /> Ca16ec cle E X .,M P L JEJ 1112 3 1 Com rehensive Trip Number <br /> .ate ofC�fenda <br /> CalBacyde 2PJ mtoJlNSTRUCTIONS ON BACK OF PART L DO NOT TAPE.STAPLE OR DUPLICATE 5 2 2,4 2 6-� <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 Tile.14 CCR,Section <br /> 17041 et seq.,If a request is made for disclosure of this information.CalRecycle will contact the signer(s)of this forth at the address and telephone number provided on this form or receipt <br /> s�..-Timidle information <br /> Truck Decal Number Hauler �r±riress <br /> Business Name- <br /> Wholesale Equipment Of Fresno <br /> �/ — ❑ ❑ ❑❑ Address t� dba Wholesale Industrial Parts E� <br /> �p <br /> LcensePla*.Reumber ct-,.,., 536 Display Way <br /> ❑ Lel <br /> N:NEE ,-i CCr.mon � Sacramento, CA 95838 <br /> Ca;r iei' <br /> I caMy under penalty of perjury under the laws of the Stale of Ca:,forma that the infonnatlon provided above is true and correct.In addition,I em aware that falsification of this information may result in suspension,revocation,or denial of renewal of <br /> :ha Waste Tire Hauler Registration pursuant to Public Resources Code section 42960 an r�'*ay result in civil penalties up to S 25,000 per day.par violation or administrative pename to <br /> e section 42962 $5.000 per violation per day as described in Public Resources <br /> Driver's Name(print) Driver's Sign re ate <br /> •. . . .• <br /> ram ID Site Suffix <br /> 5224267 �m ❑ Pick Up ❑ Delivery ❑ ❑ ❑ <br /> r- E ❑ ❑ <br /> IQ Hauler Tire Program ID / Site Suffixl EE Facility Telephone Number <br /> DATE L—:❑ _ { <br /> Ul ❑ tVltofe Tire Count ❑ V;reight:iri Lbs, <br /> ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ <br /> F ❑ volume Gubie yds. ❑ V:eight-in Tons <br /> p ? J. <br /> N - 2Ei, <br /> ❑ - - <br /> E1.00 <br /> _ - Initials <br /> I CERTIFY THAT UNDER PENALTY OF PERJURY OF THE <br /> LAWS OF THE STATE OF CALIFORNIA THAT THE <br /> - _- INFORMATION PROMED ABOVE IS TRUE AND CORRECT. <br /> • • • ¢ • r •• Site Suffix_" <br /> .L 5224267 ❑ Pick Un ❑❑ Delivery ( 7 <br /> ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ <br /> m Hauler Tire Program ID ! Site Suffix Facility Telephone Number <br /> CP DATE <br /> P <br /> N <br /> ; Ft ❑LI <br /> EHH �CU <br /> a Whole Tire Courit ❑ t'Jeight in Lbs. <br /> D � Dx-❑ 0R <br /> a) 4 a Y 3 1 J�3 J ❑ Votume Cubic Yds_. ❑ Weight in Tons <br /> o Hauler Name S34 <br /> u 164 <br /> I li'7 ufimt al ......, � i!—,l LE1 <br /> j I r.l , f=:{ Initials <br /> CLERTIFY THAT UNDER PENALTY OF PERJURY OF THE <br /> tole44) TAWS OF THE STATE OF CALIFORNIA THAT THE <br /> • ! INFORMATION PROVIDED ABOVE IS TRUE AND CORRECT. <br /> 4267 ® A P�ckUP ❑ ❑ ❑ ❑ ❑ ❑ O-F] ❑ <br /> Ll <br /> 522 ❑ ❑ _ . <br /> 'as Facility Telephone Number <br /> (�a+:er Tire Program ID / Site Suffix �❑❑ ❑❑ <br /> -"� 'I-Nk <br /> r D 1L—II ff <br /> :.tri -- ❑ ❑❑❑ ❑❑❑ ❑ L <br /> ❑ ❑ <br /> to ❑ Whole Tire Count ❑,Weight in <br /> CLLt <br /> �, I F .❑Volume Cubic Yds. ❑ Weig,rk 'ns <br /> Q <br /> �.Q _ - i J ..,_.f:!": F•aUE�S' Initials <br /> (N/A for: I CERTIFY T HAT UNDER PENALTY OF PERJURY OF THE <br /> .. „c---F f'AI IFORNIATHATTHE <br />