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Comprehensive Trip Log i=&.- Load Information <br /> cility Tire Program ID Site Suffix <br /> 3741936 -- AF/ <br /> ick Up Delivery <br /> U <br /> Hauler Tire Program ID / Site Suffix G Facility Telephone Number <br /> DATE � ;` <br /> _ w hole Tire Count Wei ht m Lb <br /> NHN�oa ® ® o <br /> i 380835 01 g s. <br /> [i\ie�-✓f 7`7' <br /> Volume Cubic Yds. ❑Weight in Tons <br /> vie: <br /> wr1 <br /> w <br /> S�' 7Cs c)r <br /> 000EN <br /> IT <br /> Initials <br /> (N/A for I CERTIFY THAT UNDER PENALTY OF PERJURY OF THE <br /> Whole Tires) LAWS OF THE STATE OF CALIFORNIA THAT THE <br /> INFORMATION PROVIDED ABOVE IS TRUE AND CORRECT. 4- <br /> PO# Contact Customer Customer TPID# Driver Terms <br /> Description Qty Cost Total <br /> Passenger Tires per Samantha apx G 1.10 <br /> C�Vr7 <br /> *Price `L \ <br /> 1.10/per pass tire L( <br /> 7.50/per truck tire <br /> (A— <br /> ,10 l� <br /> 6/f C I,! <br /> L "�— <br /> A finance charge of 1.5 percent will be charged on past due accounts.Annaul rate is 18%. Total <br /> Last month charges must be paid by the 10th of the following month.All pick up requested <br /> will have a$50.00 minimun charge whether tires were picked up or not.By signing this <br /> work order you acknowledge that service has been provided to your company by Tri-C <br /> Mfg/Tire Recycling Division. <br /> Phone# Fax# Hauler TPID# Customer Signature <br /> 916-371-1700 916-371-8181 1480835-01 <br /> Date <br />