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' r Dept,Of ROAM006 Reoyoling and Ret:b4e <br /> CA Comprehensive Trip Log and'Reaeipt§ 10002 P.O.Box•1280,SaOTOm0nlO,CAA681P—t2 9 <br /> ,jQ. .E X A nn P L E 2•P31- 1 e Com rehens(ve Tri Number <br /> �I <br /> IY11e olClF/a a <br /> cret�JTr/swn�rpl1.NSTR.UCTIt)NS ON BACK Qi"PART 2 p0 NOT TAPH STAPLt=•OR DUPLICATE t�''� - '��Q� •� �s`��*`� <br /> s sE+,,.il',r"4•S*'�--'va:trs. t :..l Sts. <br /> I 1lnplM+ Log <br /> 7041at..q,;If aiPgoee1.made1,e.dleglo+uio of I , roqtalle <br /> hrym001116. lo ivll1o0 <br /> lnformellohprovldldbnlhltformW0lhecoonHdvrquololnolldoln.nlloml,ryerropprrolevpry/.aannd IInledolloiot.InwesrdanaowithTlUo,14COR,edolio iis <br /> form or taaalpt <br /> `�' � � ` ��� c��_��n •��' �� •`Hauler Address �� I <br /> ,�, �,�� Business Name <br /> jIr .f: Addresb <br /> City,State and Z( � <br /> _bA11�Q,:}l_ai� 'r u�==xR�.���,.• ���,a =„� s.,r p . <br /> 7r �Lf �=i'®� El comma" <br /> �LYty'Pr�1 �l —115 <br /> ' ... .i... ..t #. r Carrier <br /> I eittlfyundot pMtelly of ROIIpry andeliho IIg3/of Iho Stine o!Cp4lanla Ihat Ftil lntarmaUon pmvlded ahovo Li true and correoL In adtllllon,t pm ewere Ihel f11s10cptlon of IhH Inform+lion gley rosult M mipension,rovocallon,or denlal.ol r neaol of <br /> Iho Wpfl/Tire H/u1gLfl101strellon pu,duant to Pubtlo Aesourco+Coda asollon A2080 and may is suit IK olv0 penallee up l0 3 26,000 potdoy,per Wot+(loq ocgdm4iletralNe pene4lea.Vp l0 55.000 pet vlolellon por dayes tloscdhed In Pubik gesourco <br /> ,Ood*:oplkxl.A,¢e52 <br /> �t q�tsl� • ,ca, � yca�, �9_ _^r <br /> ^_ Driver's Name(print) Driver's Signature batt <br /> c, <br /> 1 Qsl1 / <br /> i <br /> e.4rlm7y3' '*.Gytr <br /> 6054556 <br /> ARM 01 <br /> i1��>8� <br /> a � J a�y Agars s ""t ❑ ❑'❑ '❑ C <br /> Haulf3i'Tlre;Rl'Qgrain•IR';/'r Slte Suffixt on�:Niafier <br /> h,,:�;r;�6 �t eta;>! ! ,����4 ';!;'^=',•�t': •'�� <br /> ' �. tai .i° ,I` .R. �;; ❑: <br /> y Faollit B1lsin! y <br /> � i <br /> Nasi dse <br /> Faulsr Na ka y, tate aI; ll: J <br /> j Stamp or(�abol a C ' <br /> �:' hone N 1 <br /> M <br /> p umber n�4 I �Haf El Addra <br /> Haulor'Teless Same as Hauler nlllals — <br /> ,y •'r+r'ti1'" <br /> rdn ^,J=,,t� ;11: ` H_r,,1°,T�+x,*•;,,a{jIt'?��.��vkt;t,,.!�.'"t k 1 S'+'.A <br /> ENALIFPEJU� OICERTIFY THAT UNPBRF T., <br /> HE <br /> LAWS 01'1ieSTATe OFcALORNIATYTFE <br /> l:t.'trr.:"� .^.�=,3+•-.V,:..•t:07%•1.;`-•�fi',ir i�'i�"•::-ro ": ;r?f 'J :INEORMATIOHPRO-WOkABOV CornprehensiVe Trip Log Number Load 18: UE'11 DCO REOT: <br /> Information + <br /> rogram ID Site Siuffix <br /> 6054556 <br /> .Hauler The Rlogram=1p';•/ .S[terSufffic: y' <br /> � r <br /> 1� : ;a _'a;.:`;;;}:::rk,_,",p.,:d; �`a ;g"it;:" �!�J� UE <br /> 10(�i(lG�pY1f1�1 ' �(�Ilrlsg"f1 "�` }l� *—'c®.®....,a HER[ <br /> �.•4r IG- •✓..v.<+ t•r.;}T.x� ❑ ;,r• ,,� •p7.{7 <br /> av_z,��. i114'Sfi <br /> �,j�,y�.G(,�L <br /> a��.i. wi�i' ;'; ; P•' .,r: plc►,, s7n N��1 '' I, '41 clrc�sst.. <br /> Nuler_Name <br /> ". <br /> Hauler - <br /> Address Sare as Hauler <br /> S4 '--'V•&4qxFrF'.:aiS' t"ffi nrl!la <br /> H}'� s,.; ;y2=r.TF ,7, i• r'H'•t;fTYs: 5�' N.AII �-�` (cERTIFYTHAT UNDER PEHALTYOF PERJURY DF Tfle - <br /> _ +'-"+'�• +,i*-• fg ,5?.''`.` 5,' b"•' r g LAWS COVE STATE OF CALIFORNIATH ATTH9 , <br /> `••� •-�,` �. n -111F,ORMATIONPROVIDEO ABOVt1S TRUE ANO COol <br /> RRECT.. <br /> t t 1 ♦ 1 1 1 e / ' a ) r <br /> ti !��• 9 V '3 r+ ...' �•"�.�.,.? grF }�Y9 c ,r 3� _' +�9 r ['• ,c y 1. raw 1-1`Y K <br /> t ..1:.,}•�q l(ire t13 } 1 t'j�:!'�� } f `' S f.lE .If a It1 F ci,,•,q'r• !f'r? <br /> f t:� �:+;.f'f.!r.,:;'l,'i.;_..::, t.`• yF r .�, c.,rT ! i. ;y �1 ?r1 � .: }� .:1•r <br /> .•3+:! �r7.: -.r-,.��.0}'rrH?o'T,"^s.','.u.. �� ^•r _ �L'rs�-.J;i;��IY�.r}t ,�(i`'�� i "r�;'_�,•`�1�t*_r ( <br /> iN1uiQpre l?jlry�jcjf�D� :s. s..: , � lV al? <br /> �tlfi <br /> -wLj,,lrts <br /> '.j � itf5.('�J7 ii.1{qt>,.�c�t£tt�;!1ir'i t+,',i�J�i ,�: - �j Eb}r.'s � •.�,#s a I�n'r r 1't.f�¢N, I',:!7t��� 1�,e? <br /> S 4~1: )r e�1.:. 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