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Comprehensive . . Number Load information ProgramFacility Tire <br /> 59376237- B ick Up ❑ Delivery <br /> Hauler Tire Program ID / Site Suffix Facility Telephone Number <br /> °C DATE <br /> N �I t_JPi `�ALJ <br /> a� <br /> w <br /> � nw. hole Tire Count � Weight in Lbs. <br /> m 7� <br /> _ i Ft:6i y L;us fieri ` J <br /> m Volume Cubic Yds. Weight in Tons Name/Address <br /> Hauler Name � � -amity,State and Zip"7� � <br /> U a ';tamp or Label OK <br /> H u /rjTele�peh/olnee Number <br /> �) ■ F-] Address Same as Hauler Initials <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 />