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Calllornla Integretod Weate M.-g M Board <br /> =; CA'Comprehensive Tripp Log and Receipts 10002 P.O.Box 1259,Sacnmemo,CA m"-1259 <br /> E X A P L E1112131cpm an ca Com rehensive Tri plumber <br /> crweemrpaoz)INSTRUCTIONS ON BACK OF PART 2 DO NOT TAPE,STAPLE OR DUPLICATE 3740750 <br /> BY Ilpnlrq ade CA CampnReneM TMP Lop Intl RIPa A art elprrr(I)'-u""R OIO IMOm w praYldetl On Ny 1p 141100 Cerlaltivetl oonedemyl,prOP ,v aw am noel 1n eOmN I1 illy,14 CCR,SO w <br /> 17011 H sep.,M.-.—y—IOr dycyeun a N.IMomun NO CIWMa X111 mMact UM elpnar(e)w Ny ham at Ne tlCrma OM Mep11oM numaer P—N on NIO tprrrl Or re m .I <br /> vehicle Information <br /> Hauler Address <br /> Truck Decal Number Business Name <br /> d Dug D AddressTRIC MANUFA R NG Co.INC <br /> City,State and Zip <br /> Liven a Plate Number State Tke Recycling p/ygjpn <br /> a al ❑ Common 520 Harbor Blvd. <br /> Carrier West Sacramento,CA®58g1 <br /> I wn�ry under p.nalN al paqurY• neer uw,mwa w N.sm.a auany Nel uM Iniam16an prWdad.Ima la we ane wl.0 m mdWon.I em swan NIl IaI1M non w u eu ail in aaeperwon,n.p®mn,or aewl w nnagl d NI <br /> Weay M Hauler Repntrelion puma 1O Pudk Rsmurcee Cade section 12960 OM may WI n—1 panabe up t0 S 25,000 par day.per rf Watbn tlminilb nva pe es up Io 55.000 par lanpn per day u deazal W d m P.W1,Raourws <br /> COde seed^42962 ,�j �i <br /> Driver's Name(print) river's Signa ure <br /> Date <br /> �U*U1 ( dGtm <br /> 374®75 � : 'Pick Up ❑ ®eolve� 0 0 0 0 0 0 0— <br /> Hauler Tire Program ID. /.Site.$uffix Facility Telephone Number <br /> DATEDDDaoaD0D0 <br /> A w❑Whole Tire Count r' Welght In Los. .,•, <br /> .l �Facill Business <br /> d I I o Volume Cubic Yda,a Weight in Tons Naltl' Address <br /> E Hauler Name City,State and Zip <br /> m f I <br /> ci Stamp or Label OK I <br /> Hauler Telephone Number Ono 00 ❑ Address Same as Hauler <br /> /A I CERTIFY'GM <br /> AT UNDER PENALTY OF 1-URY OF TME t l <br /> LAWS OF THE STATE OF CALIFORNIA THAT TME <br /> NFORMATI N PROVIDEDABOVE IS TRUE AND CORRECT. <br /> --3 7 4 0 7 5 00 �i�x a�� Deiiye , <br /> Hauler Tire Program.ID / Site Suffix T Facility Telephone Number. <br /> y DATE <br /> c 1480835-01 w ,Whole The Court Weight In Lbs.; <br /> D;❑D-D D D:D.❑D <br /> I MANUFACTURING CO.I Facility Business <br /> d 1 iS Volume Cubic Yde.:a Welght In Tons .Name/Address' <br /> o_ Hauler Na a City,State and Zip;. <br /> v, West Sacramento;CA 95691 _— — — -- - - - --:-.r.- _ — <br /> c)[ . (916)371 8090 rddie:� <br /> or.LbeI OK: <br /> Hauler Telephone.Number �o❑❑ ASame as Hauler mru,�: <br /> I ]MAT UNDER PENALTY Or PERJURY of THE -�-y <br /> .. ..WhoN^real LAWS or THE STATE of CALIFORNIATMAT SME <br /> INFORMATION PROVIDED ABOVE 15 TRUE AMD CORRECT: <br /> 3740750 �jcx,up ❑ Der�e� V ���I�U ®�❑uu❑lu <br /> Ha6ler Tire.Program ID /:Site Suffix � Facility Telephone Number <br /> ! <br /> DATE ®© / �® / �.®D <br /> D <br /> t°o w DWhole Tire Count El Weight In Lbs. f <br /> 1480835-01 CL Ft. a!nn sine�I <br /> d M N F C UR NQS.IN . �gVolume Cubic Yds. Weigh t In T,s No HauleTbVaRBCy Ing /vs/On Vtpn<t}A �wv}7 I`- <br /> q 520 Harbor Blvd. <br /> A9 1r $tam4inAs�halC '�Z <br /> lj�7 <br /> ler Te(9b6))37 t8.08.r ❑❑ ©❑Q p ❑ ❑ Address Same as Hauler WHO. <br /> I 1 CEF1AWS OF]MAT UNDER PCAUFY M PERJURY E TME <br /> (tl•/Actor 's <br /> LAWS OF TME STATBOF CALIFORNIA THAT IME <br /> WlIOPa Tlrea) INFORMATION PROVIDED ABOVE M TRUE AND CORRECT. <br />