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•� �r r ��rrr w{.77t.•VtZV LrV • R' 2.Vw-eJ•e•Ve ■e`e` I I•r/•.V <br /> SAW or <br /> ,rs� ,1NSTRUvnoNS ON$ACK OF PART 2 DON TAPE STAPLE OR DUPLICA <br /> of lfi'}+aLit 1'.ACamR•4tenely Tft Lop end 4•e@tpt.*&WW1•f(sj tegtt••t:GM the Wonnetlon provided on Ude fonn will be conddered edroldenrl411,'P°•prfeLary <br /> t t1R••ieli>•,Ve•utlt••d•t•r dYcb•ve or!At•it71or111Mbtt,cwwcpd• RovMt -: <br /> wfy eont•ct the sfpner(a)of[Ne loan•{the address end tldephati•nturtbu� ed <br /> Hauler Address . <br /> H.E.R. TRUCKING INC <br /> Business Name ! "',; <br /> 11 { t 6 Address 715 S MAPLE AVENUE <br /> L_. City. State anti Zip <br /> i �htt�mber state MONTEBELLO, CA 90640 <br /> ! � Convttori � <br /> )jy�f iPl 15 17Q ! 1 Lei LCJ LAI ' :.arriet. I— <br /> • ,d.w aa�xe�s trn-and..o ro..t In addat—1 am-woo In-'t-Is1I callpn pt m v.Iormaupn,nay reswt 1n sus Penson re.00aV—.or aenl:,l of rene�,al et <br /> i ..-^ ..rr� .+:•. v s.. ;�r"•a ,^ - "'- -- -- ' r pen- P 000 Per violation per day as described In <br /> axq• s r. ,rrs�•x s..+n.�s�.n i.va sn't -12 u w may rosuit.r..rv�ponwlt os up In 5 25 110 por tlay per viol-ton or administratrvo Itle..u l0 55 Public Resources <br /> Drivers Name(print) Driver's signature Date <br /> ComprehensiveFacility Tire Program ID SAte Suttix <br /> Trip Log <br /> -- Pick Up Delivery —❑❑ <br /> c <br /> 5562302 C ❑ ❑ ❑ ❑ ❑ ❑ ❑ <br /> acility Telephone Number <br /> � Hauler Tire Program ID / Site Suffix DATE ❑❑ / ❑❑ / ❑ <br /> s <br /> aw ❑ Whole Tire Count ❑ weight in 6]b _— <br /> ❑❑ <br /> ❑❑❑ <br /> a E] Volume Cubic Yds. Weight in <br /> cHauler Nanne , <br /> r _ <br /> 0[][] <br /> H � I <br /> Mdrit•ess Swl-ne as Hauler Initials <br /> . ,,?phone Plumber `- <br /> (N/A CERTIFY THAT UNDER PENALTY OF PERJURY OF THE <br /> WholeLAWS OF THE STATE OF CALIFORNIA THAT THE <br /> INFORMATION PROVIDED ABOVE ISTRUE AND CORRECT. suffix <br /> Comprehensive Trip Log Number Load Information Facility Tire Program ID Sitte <br /> 5562302 -- B Pick Up X Delivery <br /> v Facility Telephone Number <br /> Hauler Tire Program ID / Site Suffix <br /> DATE <br /> c w ® Whole Tire Count ❑ Weight in Lbs. _ <br /> a <br /> 1 8 0; gl 31 1 Volume Cubic Yds, h i Tons I TIR &Vdl-IEEL <br /> no <br /> o dr : r tdarrl 0 O 171E. U► R�IJIJLMJ <br /> TRACY, CA 95375 <br /> H.E.R. TRUCKING, INC ~ 0 <br /> V _ Q aAt ', iS`s ��3T�1'� �S �Y�_�_l�EC Initials <br /> �£�juiet' Telt?r hone NurnbeY `�_�, r rr.tnco o'."TV nF PERJURY OF THE /1 n _ <br />