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�� (� p'� I}�1 �(I i� �y Celltomle Integrated Waste Msnagement 8oa1d <br /> "N+omprehensive Yri Log and Receipts. - 0002 � P.O.Bo:1259,Sac—to,CA 95812-1258 I' <br /> Ill\ \-V,I , Com rehensive.Tri Number <br /> E�x ail P: �: E1112131 3705800 <br /> aM20(105)INSTRUCTIONS-ON BACK OF PART 2 DO NOT TAPE,STAPLE OR DUPLICATE <br /> BY.lynlrq MN,CA CarnP-1w THP Loa.ra R—IIIK e+.Ig—(,)rFw•.1 avM IM Inlwm.tl.n prP ded on IM.A—MII m c mNN,r.d cwO,N,Uel,PIopl,wq. ,t d... YL In.xo I—MN Tlae,lA CCR,Ssclbn <br /> I7O.1M.aq.,N.—I—IMm.M for dlac1—o1.1.Mform.I-IR.CIWMe MB cor 1-Mener(.)al Ml- MIM.dl—..r b1"p numWr p-Ad.d on INl.loan or—IM . <br /> – Whicle Information (/ <br /> Truck Decal Number Hauler AddressBusiness Name <br /> o,o a a a ❑ Address 13 S S V U-7 11 C'E NTF Jl ST1?E FT <br /> City,State and Zip <br /> License Plate Number State <br /> ® a ® le r Carrier <br /> cerLly u,9.r p.n.ly of paRury orae,me law a d,e Sul.al C.Yfornl.N01 Iln Inronn.4on paMd.d.Cove 6 true end conal:In eddiEon, em ewr.IMI I.I.Mr�pwl W d,i.vlbrnulon may r..u11 h wspen.bn,nvor'Jlbn,ar denial of rerl.wl a dN <br /> Wa+b Tl,e NauNr R.�.tr.don Purwanl b GUDIs R.sourtas Cad...ctlon•1960 erW rtuy re.Wl ut o+p p.--up to S 25,DW per dal.Per vidaeon a.dmv,utrntrw—10..uP 1.1;'j.000 P.r Ntlalim p.r daY ai dewlped in Pudic R— <br /> Cod.aectnn.296] \\ ' <br /> _ 09022071914 <br /> Driver's Name(print) Driver's Signature Date <br /> k d 3705800 C ❑Picts;lip F7 Delivery <br /> r ¢ Hauler Tire Program ID / Site Suffix DATE HE/ j Facility Telephone Number <br /> CL ❑Whole Tire Count Weight in Lbs. Fi4�IM2S NM, <br /> k tg I N o (jl Volume Cubic Yds.l JU Weight in Tons rGIF" AL111FE)IR JiA, INC. <br /> E "—h c• t� _ 7 <br /> II o Hauler Name Tbbzb q-CY2A0Mg PASS RD. <br /> A <br /> Hauler Telephone Number ❑ �° s Hauler <br /> e mrua/a <br /> dol /f/ 1 Q _/// l— (N/A 101 I CERTIFY THAT UNDER PENALTY NI PERJURY OF THE <br /> `/J/ N� Who/IA Tf9a) V`"OF THE STATE Of CALIFORNIA THAT THE <br /> PSRCVID ABOVE B TRUE AND <br /> •. ��. _..V'� L'i°"C�1°J lLLE1lAl1AAC.1.11`.UU U LL/l7 � C lASy C.l°.1AAP.3 ' <br /> 3,705800 o [2Pick vp ❑ Delivery E H Rf a a a [?]—fl <br /> a <br /> 4U2y Hauler Tire Program ID Site Suffix ❑I ® � �� / �® <br /> Facility Telephone Number <br /> DATE <br /> I <br /> M a ®Whole Tire Count ❑Weight In Lbs. <br /> ❑ ❑ g Facility Business C) <br /> 14; 3 / o U Volume Cubic Yds. Weight In Tons Name/Address j^ <br /> E I Lj.GNI i III <br /> o Hauler Name / / City.State and Zip <br /> U _�1 G V r T 1-I 1( r Q❑❑ G ; (� ftl Stamp or Label OK <br /> H'aGlerTelephoneNumber ❑ ❑ Address Same as Hauler mrome <br /> 2 I CERTIFY THAT UNDER PENALTY NI PENURY E THE <br /> Whole Tlrea) ILAVM NFOAOf TME STATE OF CALIFORNIA THAT TME <br /> ����p�p����L��p�p������,,y����p���/ ��.�-rj�- �..� INFORMATION PROVIDED ABOVE fa TRV AND CORPECT. <br /> �...ti"wE,J..' L`l.°C.10 llA2A�1lAAC_lll IJ L @ df�l• � CAAi�Cly 3705800 00 A p. ickup E] Delivery H❑ aHE <br /> T r Hauler+Tire Program ID / Site Suffix Facility Telephone Number <br /> � DATE HM � Ha/ <br /> ..[Imn. Whole Tire Count ]Weight In Lbs. "� ; eNP <br /> 0. a: Facility Business ��'I/� ✓ � <br /> E0171 Z ? o ___O � �Volume Cubic Yds.❑Weight In Tons Name/Address �v/V r:::- <br /> Hauler <br /> o Hauler Name _ F City,State and Zip R <br /> yy 7/– a PER, EEOP �sc�� <br /> U CS7(n� 'S 7 /- _f. Stam or Label OK <br /> Hauler Telephone NumF�er Address Same as Hauler mm?O G <br /> O (N/A 101 I CERTIFY THAT UNDER PENALTY OF PERJURY Of THE <br /> WRDIB Thea) UW9 OF THE STATE OF CALIFORNIA THAT TME <br /> MFORMATIOM PROVIDED ABOVE 0 TRUE AND CORRECT. <br />