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Comprehensive Trip Log Number Load Information Facility Tire Program ID Site Suffix <br /> 3740233 -- BTSuffixDA�TE <br /> Pick Up ❑ DeliveryEL <br /> Facility Telephone Number <br /> °' Hauler Tire Program ID / Site / > ? / <br /> 11 <br /> y ©0 1 = moot� <br /> m Whole Tire Count Weight in Lbs. <br /> �000000 <br /> Z G © .Z- z Volume Cubic Yds.oWeight in Tons _me/Address <br /> G 0,5E City;State and `lwuler NanceUGIT 9sof Ce- Z�-, arnporLabelOK <br /> OOD■ Address Same as Hauler Initials <br /> EE <br /> Hauler Telephone Number _ <br /> (N/A for I CERTIFY THAT UNDER PENALTY OF PERJURY OF THE (� <br /> sop �+ Whole TIreS) LAWS OF THE STATE OF CALIFORNIA THAT THE IIv(\ <br /> INFORMATION PROVIDED ABOVE IS TRUE AND CORRECT. <br /> Comprehensive Trip Log Number Load Information <br /> Tire n Program ID Site Suffix <br /> a <br /> 3740233 -- C Pick Up ❑ Delivery I © —� a <br /> Hauler Tire Program ID / Site Suffix DATE Facility Telephone Number <br /> � �Q � / �® / M—EON <br /> w Whole Tire Count Welght in Lbs. lip0000 <br /> Facility BusinesseC c,—k nk / ,�•�„Fj <br /> m` ( �, 0 2 G ~ Volume Cubic Yds.❑Weight in Tons Name/Address L`!0 6L v' <br /> E Hauler Name City,State and Zip <br /> W f T ` <br /> $ oC-47-0 2c' <br /> U Stamp or Label OK <br /> a Address Same as Hauler <br /> Hauler Telephone Number ■ � Initials <br /> �/,y1 (N/A for I CERTIFY THAT UNDER PENALTY OF PERJURY OF THE Q <br /> SOS-� � 1 l�s Whole Tires) LAWS OF THE STATE OF CALIFORNIA THAT THE U� <br /> INFORMATION PROVIDED ABOVE IS TRUE AND CORRECT. <br />