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12/30/2014 01 :51 IFAH isacramt @eastbaytire. com Dianne Amaral 4015/015 <br /> Toll Free 1-866-896-0600 / www:calrecycle.ca.gov/Tires/ <br /> Dept.of Reedurcee Reeyding end very <br /> Oa comprehensive Trip Log and Receipts 10002 P.O.Box MID,%9rom*m* 72-IM <br /> � � EXAM p L E= 1 2 3 1 Com rehenslve Tri Number <br /> r. <br /> ' tNSTI�UCYIONS ON BACK OF PART 2 DO NOT TAPS.,/�PLE C�R DUPLIPATE <br /> By algning thle CA Campnheneiw TrIp Log•nd Flgmlp4 the elpn■rt■)requ■et Wet the Informatlaa proV16W on thle lean W18 bo oonaldered 0WIdOral•I,OMPA611ry Md Inde 04"L In a 09.1-r a wIm YIN.,ti OWL OKtlert <br /> 17641 K MQ.,11 a mqu eT to meds TOr Olep[eeun of thl.Irtf.—Uon,004--yvl■M11 conW the•lgntr<•1 of tHa farts at Er address and telephone mlmb■r provWrd On 01114,61 Or neaelpL <br /> Hauler Address F_ Cost Boy Tire Company <br /> Business Name <br /> Ihy Q �1 � <br /> Address 2200 Huntington Dr <br /> ) City, State and Zip r I,,f t�/� <br /> 533 Commonai1 ��iiVr 1.1 ! moi <br /> c 4 Carrier <br /> I U11IN undal penalty Of PIVY Undw the IWEo(th•State of CaWornle that the Infomiatbn provided above It true end Mn.et.In eddrilon,I■m aunts that MbUffit0110(d4b Id(WITIMlan May MW III Moonmim,r-moallon,or den1■1 of�esrel of <br /> the Weete The Halder P491.1raUon pUrtdant to PubUo Heeoraca.Coda■aatlon 42.50 end my—11 In dvtl p-111w*up b E 25,000 par day,par Nolallon of edmlrMtrallve penahlaa up t0$5.M0 p4,VIOral)en per del aa.daaarlhed in Pubilo Raeoumee <br /> Code motlon 42952 <br /> al ra r <br /> Driver's Nsme tint Driver's SI nature pate <br /> Comprehensive Trip Log Number Load Information Facility Tire Program ID Site Suff ix <br /> Lk <br /> 460990-� Cz <br /> 'Hauler Tire Program-10 / Site,Sufflx ., f Facility Telephone Number <br /> 3y Tl. 'µms r, wv 1;' �' �, 't+h 14 n'„„` y^,•• FL <br /> ,key.. F. ,., Tire Company <br /> Hauler Name : <br /> Iorris nvanUO <br /> ), '1gt ' - <br /> 9r <br /> 58 <br /> Hauler Telephone Number L7 Ad �9r�HWea <br /> p mitis.' 1 CERTIFY THAT UNOER PENALTY OF PL'RUURY OF YHQ <br /> „� G�I / �j 7 x f°. ti,� �'�• ;-n-004 LAWL OF THE BTATQ OF CALIIC!lIN1XTHAT THE <br /> J( !p i. i„ ,✓.' INFQ tbNpliONDP�AgOY219TAUSANDCOAM T. <br /> Comprehensive Trip I.og Number Load informatiovi FAcil;iy Tire Program ID Site SUff iX <br /> 4660990-- 87 � - <br /> K0 <br /> Hauler Tire Program Ib 1 Site Suffix' Facility Telephone Number <br /> �l.. yIl? rir 4'.. <br /> •�., s - oa - ooa000 � <br /> +i;;'�,:; •I• .:t,'-. yy t<' dr_iitt\ i. t <br /> NHrit:/�,nr ., <br /> ,,.f. F r ._ ��+,,,,.. _,•¢•�r'`rrr ,:'1'r -`7 i'S1 �f'I}f ) <br /> Hauler Name <br /> a <br /> " : ..3 <br /> Hauler Telephone Number - A ass Same as Hauler <br /> l.,`,..,. rkyr,;t,;-�, "r, w -•_ f P,��T 1 CERTIFYTHATUNDER PENALTY OF PERJURY OF THIS <br /> hb„ f i,` LAWS OFTHIBTATECRCALIFORMIATHAYTHC <br /> 1NP0RMATTONPROVIDEDAAoVE1e TRUE AND COMt4CT. <br /> e <br /> 460099. Ell 14 <br /> In:n �. <br /> Hauler Tire Program ID / $lt6�u i'x I 9. "l 7fit fieTalumber <br /> ,h „�,l;t-� t)itil:?�IF.•T�fT1 9 9i,'i ,Ch p+i -hr1' <br /> 77 <br /> Hauler a :•,., •r t, ” .1 t 1 I <br /> FU <br /> �'r�ltrmtt�I:L�Y;�.i� .�? 'o��t, 1'`stF." ,�s:� �+r;i n�i•� �•,,1;�.i ti;��rrfj���T't�b�3ft�4��� - r E' <br /> Hauerne.�p d @r ! ss2aii uter -� <br /> ••7' _ l.. '1�,.�'•� .1--r_I .'r-cYatil�'r.i'.r <br />