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COMOMI.Integrated Waite Management-Board <br /> .. CA Comprehensive.Tri Log and Receipts .10002 ' P.O.BOE 1259,Saammma,CA95012-1459 <br /> E Ix a Aa P G E s 2 3 comprehensive Tri 'Number <br /> civEe'xa1(D0s)INSTRUCTIONS ON BACK OF PART 2 -DO NOT'.TAPE,STAPLE OR DUPLICATE 3745207 , <br /> BY 419OIN BSI•CA C0ngmN n.1w TOP Loa•rM R• IPL DM M9mr1.1 nNq_.dui tlu IrdonnaUon povW W«i aro f«m r lY p.eonFlMnO wnDMnWI.PruPrIF4ry and uFE•aFcnL In FcmWnq MN 1H4,.1.COR.8•ctlon <br /> ' Iron«.p..S•rpu•.I 4 nub far d4cb•un d tlV.Iddrm•dm,aM CNYMB.111 o•nba tlu.pn.R.l d th4lorm«ur•Wdrm•.rW 44dnns mvnbsr provhlM pn tlU•fomn«rvlpt . <br /> e e e In ormat on 'Hauler Address <br /> u <br /> Truck Decal Nmber Business Name 006t �' UTO T�i'ZE A!il/ EE <br /> ® - Address i 39-5 - sv.uTtt c-o-P.-m-r?. sTjzEF_-T <br /> City,State and Zip 7EM)e_Kz1_0 N <br /> License Plate Number State 12 0/ <br /> Carrie qn o <br /> ub)'unbr p•nalry a pMar IAM«ale 4w a Ind Slav a Ca111«Ne Nit tlu Inbmlalion p,wWa a4dw I.M and oHrea.In•eelibn,I'm p•on No141FIOu1bn of M4 NiMrutlon maY nwX N wwnalpn,nvmlipn,«d.nlal a ronewM a DO <br /> Wmla T4s Maul«R.giMrabon au,u M M Publk ROWurus Coea FaGlon 42ND ON may'mull In GW mnaa4s up W f x5.000 qr d•y.p«OIAOdm or OIPmnwnd MO.up IP$5.ODO p«YOUNI.p.r day•a dataibad In Pudk R•FPurma <br /> cde•.aav,.xeBx <br /> 09062070020 <br /> Driver's Name'(print) Driver's S§nature Date <br /> Program9a .. <br /> 374 5207 _-- C Pick Up ❑ Delivery a a UN a <br /> 41 Hauler Tire Program ID / Site Suffix DATE Facility Telephone Number <br /> m uta ❑Whole Tire Count Weight In Lbs. a ®❑ <br /> FF—acility Business <br /> pu El Volume Cubic Yds.11 Weight In Tons Name(Address <br /> Hauler Name City,State and Zip <br /> U /1 ( g Stamp or Label OK I <br /> atiler Te ep one Number a..❑❑❑❑❑■❑© ❑ Address Same as Hauler ramal: J <br /> (N 1A r0! I CERTIFY THAT UNDER PENALTY OF PERJURY OF THE <br /> Whole Ti_) LAWS OF THE STATE OF CALIFORNIA THAT THE <br /> INFORMATION PROVIDED ABOVE IB TRUE AND OORRECT. <br /> Comprehensive •• Number Load Information Facility Tire Program9 <br /> Site Suffix <br /> 3.745207 -- 8 Pick Up ® DeliveryH a H M E O ©—o a <br /> is Hauler Tire Program 16 / Site Suffix Facility Telephone Number <br /> DATE <br /> q ® ❑a- ®®©r ®© <br /> Whole Tire Count []Weight in Lbs. <br /> FAcilitYQOt:DE?P6y-66: INC. <br /> d <br /> E] VolumeCubic Yds.'[]Weight In Tons Name/AI'l_3000 NEW RD: <br /> E Hauler Name City,State a BAL''LICO,CA95303 <br /> P a❑❑❑❑® ® ❑ P <br /> (219'-668-4855 <br /> L) <br /> 11 n 'Stam or Label OK <br /> auler Tele hone Number ■ IL—fl rl Address Same as Hauler IRmaIE <br /> i <br /> IN IA for I CEPTIFY THAT UNDER PENALTY OF PERJURY OF THE /+ <br /> Md.Thea) LAWS OF THE STATE OF CALIFORNIA THAT THE (L- <br /> IN-FIMATION PROVIDED ABOVE M TRUE AND CORRECT. <br /> Comprehensive Trip Log Number Load Information Facility Tire <br /> Site Suffix <br /> /� Program9 <br /> 3745207 �`'� Pick Up ❑ Delivery ® W ® ® © F31-® M <br /> / Site Suffix' �. Facility Telephone Number <br /> Hauler Tire Program ID <br /> DATE a5 /.EU / <br /> s - <br /> rc0 aw 2'Flhole Tire Count ❑Weight In Lbs. <br /> r Fa2ilit Business <br /> O I E]Volume Cubic Yds. Weight In Tons Name/Address <br /> E �1 tr Cu�HC <br /> Hauler Name City,State and Zip e�v c l g /• <br /> K)'MC iv-6ivD <br /> _ N F `❑❑®�a �a Stamp orLabel OK �ulee-/q014 1 <br /> Hauler Telephone Number ■ Address Same as Haule�.A <br /> (H IA for I CERTIFY THAT UNDER PENALTY OF PERJURY OF THE C <br /> ') WMro Tim) ZS OF THE STATE OF CALIFORNIA THAT THE <br /> INFORWI N PROVID D ABOVE LR TRUE AND CORRECT <br />