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Amok <br /> i <br /> fil <br /> . : J6 Fro . . <br /> 4851146 -- A Pick Up ❑ Delivery <br /> Hauler Tire Program ID / Site Suffix Facility Telephone Number <br /> � DATE ❑❑ /... � `S ,� ❑❑ HE- PPPNgRH <br /> a <br /> a ®Whole Tire Courw Weightin Lbs., <br /> d d a U d ( ElVolume:Cubic X21 . []-Weight in.Tons P4 j, P_5 r <br /> E Hauler Name <br /> C: <br /> y ��- <br /> R � ,I� <br /> (� L/ /'" Stamp'gid' 3, ei J."", <br /> a <br /> Hauler elephone Number ■ Address Same as Hauler initials <br /> (oleTr I CERTIFY THAT UNDER PENALTY NI PERJURY OF THE <br /> 'IC/7_ tJ Whole Tres) 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 I-D Site Suffix <br /> 4 8 5116 8 -- A Pick Up Delivery <br /> ¢ Hauler Tire Program ID / Site Suffix l � Facility Telephone Number <br /> DATE <br /> OR - ❑❑ <br /> 61 / '<a Whole Tire Count ❑Weightm t Yis.; <br /> 571-0k b*essc <br /> aao-o©ooaa� <br /> m El Volume Cubic Yds:, IM1feight in Tiaras N e/ ddress <br /> Hauler Name C � / t / aYk4 , �Q„4�d <br /> or Label 0=' <br /> FaulerT ephone Number a Address Same as Hauler <br /> z9 , <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 /> VIM• • • • <br /> • <br /> Q 4 8 51191 -- A Pick Up Deliver , <br /> El <br /> oo ❑ � ao <br /> Hauler Tire Program ID / Site Suffix Facility Telephone Number <br /> DATE C�LJ /. ©a. <br /> Q. Whole Tire Count ❑Weight in-Lbs. <br /> 111 © oa- oaooa3 <br /> m d c, , ❑Volume Cubic Yds.❑Weight in Tbns c �� e <br /> oHauler Name <br /> y �� ►- ., sdaC Kin C�. <br /> LHaialerTelephone Number Q ■ E] Address Same as Hauler <br /> initials <br /> (N/A for 1 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 />