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Comprehensive Trip Log Number Load Information Facility,Tire Program ID Site SUff ix <br /> 5686825 -- C Pick Up ❑ Delivery <br /> Facility Telephone Number <br /> Hauler Tire Program ID / Site Suffix DATE <br /> . �- � �0000 <br /> c Lu Whole Tire Count El Weight in Lbs. <br /> M a. Y Business <br /> f_ .a <br /> 0 11 3 (� ' 17 CJ Volume Cubic Yds. ❑ Weight in Tons I Nd <br /> E Hauler Na tarty, Stat anc,z :, <br /> Cn P Q a Starnp or Label OK <br /> Hau ■ F:-] Address Same as Hauler Initia <br /> er Telephone Number ls <br /> /// (/�/` r�7 (N/A for 1 CERTIFY THAT UNDER PENALTY OF PERJURY OF THE <br /> /_ / - /�"�%/ Whole Tires) LAWS OF THE STATE OF CALIFORNIA THAT THE — <br /> LY ` 666 1 INFORMATION PROVIDED ABOVE IS TRUE AND CORRECT. <br />