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C.IIfonlb IR�bw w..b M—prnMn a—d <br /> = CA Comprehensive Trip Log and Receipts 10002 . P. B—1259,3---nco,CA fN l,2-12" <br /> E'x A M; P L E t 2 3' - fi�l". _ .� COMPrehensive Tri_ Num er_, <br /> c arae'noo;,INSTRUCTIONS ON BACK OF PART 2 'DO NOT TAPE,STAPLE OR DUPLICATE 3 9 3 5 <br /> 743.1 <br /> ..By.IB,MIB this CA CmrpNrelw Txp Lee and R-1K BI..4.MA1 n.oaal e1M ee b o-Won p.,NM on Mb f—vAU oe conular.,conrAmdal ptcpbbry vN aM aM:in evoorde ce awal new,14 CCR,Owdoo <br /> 17011 MMb.Ban.ur1 b ooM b Cbel—Meb 4lotnOM tlr OWIm MO mMeM Be.grerje)a eb Farm 0 the e0an..a And New—nunbr pwlaaa on bqn re.elpiL . <br /> e ICIGinformation Hauler Address <br /> Truck Depai Number Business Name <br /> Q <br /> Address �3 <br /> City,State and Zip r <br /> License-Plate Number State <br /> Common <^a l <br /> .Carrier <br /> tunny unbar penrry al parjuryryry���yyy M��-e InW Itto 51.4 of C.lifomla In t tte Inbnma Ma deo above h—and crin.p.In.tld8ion ra MM bblcoatbn of No IMumaBon may result N aucp—,i—on .M—.1 of removal of <br /> 1 VA,su TVe Hauer R Gaol b Poly Rasournxs Ibn 02880 and may iasutt in dNl penMtbl up b 1251100 pr�vr-.O'S <br /> trativa pen IGea up to MOM par Iatien per dry d.ac O.tl in Puplie Rawu <br /> COM }�7iik l l'Y1 CL.- 1al att �' j — O <br /> Drivers Name riot Ef ature. <br /> 6 <br /> Comprehensive Trip Log Number Load Informatiort Facility Tire Program ID Site Suffix <br /> -[:] <br /> -3.9 3-87 4.3 Pick Up [:] Delivery <br /> Hauler Tire Program.ID / Site Suffix Facility Telephone Number <br /> DATE <br /> coo-0000000 <br /> w w O Whole Tire Count Welght In Lbs. <br /> � (Facility Business <br /> `m Volume Cubic Yds.O Weight In Tons Name/Address <br /> SHauler Name . City,Slate-and Zip' <br /> ■ <br /> Stamp or Label Ott ( i <br /> Hauler Telephone Number, a Address Same as Hauler a _j <br /> (N IA for I CFROFT THAT LINGER peI "Or PEA.IORIY o'T/! <br /> Who/.for urs v THE IITATE OF.CA oRNN TINT n1c <br /> D/FOAN MM PROVIpED ABOVE a TR ANDComprehensive Trip Log Number Load Information Facility Tire Program CORRECT. <br /> _ r <br /> Site Suffix <br /> 39,35743 - B Pick Up. Delivery <br /> Hauler Tire Program ID / Site Suffix Facility Telephone Number. . <br /> a DATE <br /> W w_ Whole Tire Count E]Weight in Lbs. ®� ,®®E17 <br /> f i~acitity't3u;iness <br /> m O I Q 0 Volume Cubic Yde.O Weight in Tons :NamelAddress: <br /> Hauler Name - City,State and dip, <br /> V P <br /> tam or Label OK, <br /> uler Teleph umber ■ Address Same as Hauler <br /> ,(n�a/' • (N fA for ` I DIRT UMM PFlI w a k.t .OF TME <br /> • '~� !l., •. Whole TIM) uM�of TIE SiATB.OF CAI QA TINT TIM. , <br /> V C/ INro11YAT10M PRWO)m'AeoVE IE,RUE Axe CORRECT: <br /> Comprehensive Trip Log Number Load Information Facility Tire Program ID Site Suffix <br /> 3935743 -- A. Pick Up Delivery <br /> Hauler Tire Program ID I .Site Suffix DATE / / a® Facility Telephone Number <br /> w w'®Whole Tire Count O Weight in Lbs. <br /> d' <br /> m <br /> 1101101171� O Volume Cubic Yds.[:]Weight in Tons N..'^: .• w�a. r <br /> E Hauler Name C <br /> Hauler Telephone <br /> ele�phSVo,'/Vnr(e NuCm/ber <br /> n5POIDE <br /> v, InWMM <br /> TRH <br /> /v AWS OF E eTAIE O <br /> F � <br /> O E�c <br /> ry <br />