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-w I-Ij I <br />5870403 -- B LL)kj�, Pick Up Delivery <br />Hauler Tire Program ID If SiteSuffix <br />DATE HE'/ <br />Lu Whole Tire Count Weight in Lbs. <br />I E0 1� 15 E] Volume Cubic Yds; E]Weight in Tons <br />E <br />0 Hauler Name' <br />Hauler TelepqorjeNumber <br />r U (N/A f r <br />6 Whole Tires) <br />WIMIME <br />Facility Telephone Number <br />EHN—NEN <br />Facility l3uj%0;j$- j '<'-W- <br />_ /� 7a <br />Name/Add es <br />r <br />City, State andVi07'9' <br />Stamp or Label OK I <br />Address Same as Hauler <br />I CERTIFY THAT UNDER PENALTY OF PERJURY OF THE I Initials <br />LAWS OF THE STATE OF CALIFORNIA THAT THE <br />INFORMATION PROV DED ARnVP Iq — �� — I ... — I .e� <br />i <br />Comprehensive Trip Log Number <br />Load Information <br />Facility Tire Program ID Site Suff ix <br />Pick Up Delivery <br />11 <br />5757261 A <br />Pick Up <br />X <br />N <br />� <br />UO <br />.2- <br />Ll <br />(D <br />cc <br />Hauler Tire Program ID SiteSuffix <br />DATE <br />Facility Telephone Number <br />Lu Whole Tire Count Weight in Lbs. <br />(L <br />Volume Cubic Yds. Weight in Tons <br />C <br />M <br />(D <br />IoI6�517ili 16 �crl <br />— - <br />[Facility Busulle4l, Mal <br />NarnL-/AdcB-,2--_3 q -5 j5�t Do <br />to ',-,F <br />E <br />0 <br />a <br />M <br />2 <br />City, State and Zip <br />CjA- <br />Stamp or Label OK C <br />H�)jjler Name <br />0 <br />E <br />(NIA for <br />Whole Tires) <br />Address Same as Hauler Initials , /7 <br />I CERTIFY THAT UNDER PENALTY OF PERJURY OF THE <br />LAV.V.9 .1TTHE STATE OF CALIFORNIA THAT THE <br />Hauler Tele Number <br />TV <br />0 <br />:3 <br />HaL <br />fler Nam2._ <br />IPE <br />NF RkJA ON PROVIDED ABOVE IS TRUE AND CORRECT. <br />i <br />i L <br />Comprehensive Trip Log Number <br />Load Information <br />Facility Tire Program ID Site Suff ix <br />5591572 <br />Pick Up <br />Delivery <br />UO <br />Ll <br />(D <br />Q <br />U) <br />Hauler Tire Program ID If Site Suff ix <br />. <br />DATE' <br />Facility Telephone Number <br />w <br />IL 19Whole Tire Count 1:1 Weight in Lbs. <br />Volume CubicYds. E]Weight in Tons <br />a <br />M <br />2 <br />Gilily BUS54 <br />F"A ---3 '� 5, Z1-- - 0 <br />Name/Address <br />0 <br />E <br />City, State and Zip 1;/re 1-4�17-7 <br />0 <br />:3 <br />HaL <br />fler Nam2._ <br />IPE <br />F- <br />2 <br />EEOEEWOE <br />Stamp or Label OK <br />Hauler Tjlephone Number <br />7(- <br />(N/A for <br />Whole Tires) <br />0 Address Same as Hauler Initials <br />I CERTIFY THAT UNDER PENALTY OF PERJURY OF THE <br />LAWS OF THE STATE OF CALIFORNIA THAT THE 77 <br />PROVIDED ABOVE IS TRUE AND CORRECT <br />NFORMATION <br />i L <br />