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I yQ <br /> -- p n <br /> 4656706 Pick Up ❑ Delivery <br /> a) Hauler Tire PID / Site SFacility Telephone Number <br /> U) Program Suffix DATE �a / �® / © <br /> aWhole Tire Count' ❑ Weight In Lbs. 1 <br /> L Volume Cubic Yds. Weight in Tons I 1\"a'`c <br /> l ❑ ❑ <br /> E r c.!:i Y N i;nie 1PIC <br /> � <br /> Haule toe NI "T mer ^ ■ ❑ �' `�Initials <br /> ��� / ( for I CERTIFYATUNDEJUR PENALTY OF PERRY OF THE <br /> Whole <br /> 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 Suff ix <br /> 4656708 -- A Pick Up Delivery © © �- <br /> Hauler Tire Program ID / Site Suffix DATE ��` J� / f Facility Telephone Number <br /> d _ <br /> LU a Whole Tire Count ' r] Weight Ltis " <br /> g <br /> E]volume Cubic Yds. Weight in Tonsil <br /> C 3laui-r;dame � <br /> Hal... T IeCJhoI un/G�afr LJ <br /> �i�r (ole for LAWSATHATTHE <br /> /I <br /> Whole Tir05) LAWS O TIFORNIA THAT THE <br /> INFORMATIDN PROVIDED ABOVE IS TRUE AND CORRECT. <br /> Comprehensive Trip Log Number Load Information Facility Tire Program ID Site Suffix <br /> I <br /> a <br /> 4849183 -- /4Pick up ❑ Delivery ❑ a o o - o <br /> Hauler Tire Program ID / Site Suffix Facility Telephone Number <br /> � -DATE ❑❑./. ❑� �;❑❑ <br /> � a �Whole Tire Count _ Weight in Lbs <br /> f C� ❑Volume Cubic Yds. ❑Weight in Tons <br /> 7 GL!`/ PpSst �C l <br /> yHauler Name C/ <br /> Q <br /> Hauler L000H,HE <br /> Telephone Number ❑ ;address Same as Hauier In s <br /> ( for I CERTIFY THAT UNDER PENALTY PERJURY OF THE <br /> Wholeole Tires) LAWS OF THE STATE OF CALIFORNIAI THAT THE <br /> INFORMATION PROVIDED ABOVE IS TRUE AND CORRECT. <br />