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Toll Free 1-866-8965-0600 www.cal recycleca.gov/Tires/ <br /> Dept.of resources Recycling and R--1 <br /> ir10002 RO.8—1259,S.cr—nfo,CA 95812-1259 <br /> -4 CA,Comprehensive"Trip Log and Receipts Comprehensive Trip Number <br /> C P,t- E <br /> PLE OR DUPLICATE <br /> xwa -„,,.INSTRUCTIONS ON BACK OF PART 2 nn,,d�d con <br /> h P <br /> 7 <br /> . "� D � ❑ � H.E.R.TRUcKING, INC <br /> 715 S MAPLE AVENUE <br /> 1 �f o Irl[ sl Fc1 <br /> L9 X <br /> MC)NTEBELLO,CA, 90640 <br /> C, �Jfj InA j <br /> Driver's Name(print) Driver's Signature Date <br /> Comprehensive Trip Log Number Load InformationDelivery Facility Tire Program ID wite suffix <br /> 5562100 -- C PickUpLl COU0000—❑❑ <br /> Z <br /> DATE ❑❑ Facility Telephone Number <br /> Hauler Tire Program ID i Site Suffix ❑❑ ❑❑ <br /> F❑1 Weight LIC, <br /> Whole Tire C..Ilt Weight in Lbs.VOID <br /> El Volume Cubic Yds. Weight it,Tons <br /> VOID <br /> < ❑❑ -,�7.-Iarne as Hauler Initials <br /> _ __ ... _ .I„ ._, ❑❑❑ (N/A for I CERTIFY THAT UNDER PENAL7Y OF PERJURY OF THE r <br /> Whole Tires) LAWS OF THE STATE OF CALIFORNIA THAT THE <br /> INFORMATION PROVIDED ABOVE IS TRUE AND CORRECT. <br /> Comprehensive Trip Log Number Load Information Facility Tire Program ID Site Suffix <br /> 5562100 El Pick Up X Delivery LI] b] 0 ���� , ' i <br /> Facility Telephone Number <br /> Hauler Tire Program ID Site Suffix DATE ED / ❑ <br /> ED / <br /> In <br /> Uj 21 Whole Tire Count 1:1 Weight in Lbs. ❑ ❑❑ ❑❑ T <br /> CL <br /> C"TIRE &MEEL <br /> �❑❑❑❑ i I <br /> Lbs. <br /> 3 0 9 9 6 3 0 ,J] Volume Cubic Yds. [] Weight in Tons <br /> E 227S E.GRANT L14E ROM <br /> H.ER. TF?Lh2X1Nr3, INC TRACY,CA 9537f) <br /> FC ,RN An Initials <br /> S) 3 <br /> no fl i OR SIST <br /> 5562100 -- A i El Pick Up Delivery a®❑�❑ ❑❑❑❑❑ <br />