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CalNumla Integrated Waste Management'6oald <br /> CA Comprehen sive:Tri Log and Receipts -. .10002 P.O.Box 1259,SaCan,entp CA 95512-1259 <br /> jE1XjA1MjPjLjEj 111213 Comprehensive Trip'Number <br /> civuemlfbtlb,B9sI INSTRUCTIONS ON BACK OF PART 2 .DO NOT.TAPE,STAPLE OR DUPLICATE 3745207 . <br /> BY.Igning MI.CA COMPNINI-1w Tdp Log.nd R—IA One Wgmr(s)rpu..t Out Ou InlonIuuIw prodded-&I,to"M11 W oen.ld.r•d rnnrM.nd.I,pnprteta,y..•nd••e«.L In.ce«W,c•wryR Tltn,.te CCR,S.utlon <br /> 1TW 1.t.p.,ry a rpu..l I.nude for dY.lwun of OY.IMormeOon,Op CN MB,dll eonbFl on,dpn•H.)of Ml.form M Vu.ddnas and ftle^ne n W prodded on We loan w n AIpL <br /> s=V,ehICIe,InT0rMat i jussaweiewinswiseeissigus, -Hauler Address <br /> Truck Decal Number Business Name" FGDOo�• J—AUTO--n' IV!i✓ I-E <br /> a a — ® <br /> pq_ <br /> E Address 13}-S - svuTtl Frv-7r? sT�FT <br /> City,State and Zip STS KTo N <br /> License/Plate Number _ State {� / <br /> 0 rieron � <br /> Ca <br /> �I <br /> I c tffy uMw peneM oY perlurY und«ma faun of Me Bute al CalilonJa Nat du Ir,bmieUan plvvldN.bove Is VUe.nd caned.In addldan,I em pvnn tlul lalalllutbn o/M4lnbm.tlon maY reeull in wap.nsion,nvo®•kn,«dental of ranewY o/UN <br /> Waste The Had«Regi.n,bon pursu b Publk Rewu w,Cods eedlon 62960 e,M may nqult In&4 penatlie.up to$15.000 per day:pervlolatlm«—h1.palM 1W.up to$5.000 W vula4on par dey ee d.wl d In Pudk R.-- <br /> CW.aewon�.yze,5z 09062070020 <br /> 9 <br /> Driver's'Name'(print) Driver's ature Date <br /> Comprehensive Trip .. Number Load Information .. e Site Suffix <br /> 3745207 -sess C Pick Up ❑ Delivery <br /> Hauler Tire ID Program / Site Suffix Facility hone Number <br /> 9 = DATE ® ty Tele P <br /> ui Q. <br /> Whole The Count Weight In Lbs: <br /> ® a®-®ora❑a <br /> FFacility Business <br /> d po ❑ Volume Cubic Yds.❑Weight In Tons NamelAddress <br /> E Hauler Name n City,State and Zip <br /> U n - � ,� (, � Stamp or Label OK <br /> aider Te ep one Number ■ ❑ Address Same as Hauler /rrra/d <br /> (N/A for I CERTIFY THAT UNDER PENALTY OF PERJURY OF TME <br /> LAWS OF THE STATE OF CALIFORNIA TNAT THE <br /> •/ Whole Tires) INFORMATION Pg0VI0E0 ABOVE 19 TRUE ANO CORRECT. <br /> Comprehensive •• Number Load Injorrhation Facility Tire Program ID Site Suffix <br /> a 3.745207 -- 8 Pick Up ® Delivery <br /> Hauler Tire Program ID / Site Suffix Facility Telephone Number <br /> DATE <br /> Ea / H© <br /> m a Whole Tire Count E]Weight In Lbs. <br /> FawIitydM-6ETg„Y•PRU0UCTS,INC. <br /> a_ r p Volume Cubic Yds:❑Weight in Tons Name/Acf1-3000 NEWPORT RD: <br /> E Hauler Name _ City,State aBALUCO,CA 85303 <br /> p .) a DOODE-MuOp (209►688 4855 <br /> v 4 Stam or Label OKJaider Tele hone Number Address Same as Hauler ,n,g;/�' <br /> (N/A 10! I CERTIFY THAT UNDER PENALTY OF PERJURY OF THE �� <br /> Who <br /> Tires) lAWB OF THE SPATE OF CALIFORNU THAT THE <br /> INFORMATION PROVIDED ABOVE M TRUE AND ORRECT. <br /> Comprehensive Trip Log Number Load InformationB Site Suffix ass <br /> 3745207 ,r- A JAPick Up Delivery ® Id P 2 © 5 <br /> —� <br /> Hauler Tire Program ID ! Site Suffix` DATE Facility Telephone Number <br /> /°D Iua �✓hoie Tire Count ❑Welght In Lbs. <br /> + Fadilit Business <br /> E11 Q 31711 F 1011 ❑Volume Cubic Yds.❑Wow&In Tons Name/Address A,LUTHl�C <br /> rHauler Name I City,State and Zip 6 yp D/ty J j <br /> A �f, p `DORA ❑ Address-same <br /> /I D F� F � �RE a Stamp or Label OK a2��N/oHauler Tele hone Number Address Same as Haule� <br /> (N/A for I CERTIFY THAT UNDER PENALTY OF PERJURY OF THE Pr <br /> 7 Whole Tires) LAWS OF ME STATE OF CALIFORNIA MAT TME i <br /> INFORMATION PROVIDED ABOVE IS TRUE AND CORRECT. <br />