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trj <br /> sive Trip Log and Receipts 000n D0 °t1 rrR-e ln,r.,��H.f-12!' <br /> �,N"2 Pq itor t?°f!.S•crameMn,CA 9�iAl2-t�.f,9 <br /> 1A - 1 ..i _ Comprehensiv_e Trip Number <br /> TKNN_S ON BACK OF PART 2 DO NOT TAPE, STAPLE OR DUPLICATE � 7 9 38 �� <br /> - - ��11•�-� �.�Y ..wwt�4.�1f1Y.•t.sr'_. _ _. ,. .J�..,,.M w,H�.si..t:.. I.u.e,ee+ll.+. u.sutr+u; a•«.....«�,.•. •.Aw c In qr..)yn..a MfS+T�eL+ 11 f f,R,^nr�4'in <br /> 1'�!tit.:4c ♦t�'a.ss!4 d i��agcsr+✓!a�trM�. .. ..iitV ...-^_=.e�rq,.A•%1 I.rnw N NN«ww�.n t�Ir,J._ ..r+�1.r+[r_.rNMI.: w f.a.m r�• m[M r ._ <br /> L1'tsslrpr A rlrira <br /> H E.lt_ TRUCMMM.IMC <br /> i `�0 1 a 1 *4. :.t:tla 9t„l ►� 715 S MAPLE AVENUE <br /> °ter •'� h�a4 � MONT1�Et.LO CA, sob” <br /> rar.f.,a,of <br /> _ _ ,. .�.t ... . ..: .r. t wl .ffX)i„n nF:Ntl..',t..+.i a/:.,•1r+rrs,t..M: P�,t�tf. .¢x� ., <br /> .. ... .. _.-" _.. -- `. . .... �.- _. �... I, ,.., ,,...... -.. .. n.�... « �:._aa>1:.,•.Ir[ .+..ea:,,r,r v..f,at.:: , ...,r, 1. <br /> Driver's Si nature Date <br /> 1. ":,r_ C?f�vt�r'�t fV arnn nntj - <br /> � I <br /> __ _--- Pick Up Delivery ❑ ❑ ❑❑❑❑—❑❑ <br /> 5993808 C ❑ <br /> r Facility Telephone Number <br /> QNfxuJs-s T►rv► Profar,sm ID / Site Suffix DATE ❑❑ / [IF] / 00 <br /> VOID tau Whole Tire Count E] Weight to Lbs. <br /> DDD <br /> DD <br /> Volume Cubic Yds. Weight in Tons <br /> pi;;-tulF>r hi.am� <br /> � VOID � <br /> c� a ❑❑ <br /> Address Same as Hauler initials <br /> ?�.rr.�![ts T!?lfs�:)hc,rlr FJt�rnt�r r <br /> - (N/A for I CERTIFY THAT UNDER PENALTY OF PERJURY OF THE <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 /> -- Pick U Delivery - <br /> -- .5 � p x 0 7 S 6 0 <br /> Hauler Tire Program ID / Site Suffix Facility Telephone Number <br /> ir DATE / / <br /> w U Whole Tire Count ❑ Weight in Lbs. <br /> i Cubic Yds. M�t �Gf U �iU pat I•.,.. ❑ Volume u <br /> b itttflt:r PJ�irru 27.E I—R. OST UM <br />