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 />
|