|
- --•�-- C•IMomi•JM•Brat•d Wd•N �ni.otlm.M -
<br /> CA Com rehensive Trip Lo`g a'nd-Ret;erpts Po ao-=+25p Sep„RI•f1104ILY10,2=,2a9- -
<br /> �EX'AIMI' I act L'2is,1= . -- pmpr�hen�iveTr�Number - -
<br /> ""G"" INSTRUCTIONS O.N BACK,OF PART 2 DO NOT TAPE STAPLE O DUPLICAT
<br /> 'laypyp LM r1N0lJ. R
<br /> �:Sy.lp Inp M.CA Cpmpn omly.Trip Lop and R• 114 tM.IpnM�I repuMI11W the 4formW provm•tl on tli4lonn iW11•�oomld.W M"d.nlul P.P1M.1r•nd tr•d•wcrH.In accord.nw vrllh Tk.,MAI
<br /> SacNon -
<br /> -"7Tp4Tal..q.,fll a rpu•g 1.m.d./or dl.olwuri'of tlli•Irdorinatlon,tR•CIWMFI wlll eonbdt ih��IOf�rl 1pl lbb It 01 dN Wdww•nd$A0— bar pr od on lhl,loan or wc•IpL
<br /> i1,l 1 I
<br /> 'Truck D"Numtier' s Hauler Address
<br /> Business Name .� �p !1Gt'k k✓�.
<br /> `•© L:J �.� t=J J 07109070012 AJC
<br /> .a .J,nae PIa1e Number ."• �e Add[es3; ., C A .� (�J 0 `
<br /> City,State and Zip J
<br /> L.
<br /> -Comprehensive Trip Log Number Load Information Facility Tirr Progjarn ID Site Suffix
<br /> �. .
<br /> �yyrtlrynrldwpwlrydp•r1rW'4�d•tSr anpFtii:tp•4 bl�aYlorN.btY•i•m(wmetlon w!>+�ed':bo`/..1 eu••rrdwmsal In•tldXlar l'Yrn 11Nt+sIXInllonwmbl,�,,,do tn.yre•Wl m. Wli•lOn rewupa4.«d.nl:lW rewYlof thy;
<br /> 7H N pu.uwd m Puum eod•wcuon�Zpeoynd m r�� dwl p.rwuw up m S 26 uoo py d.y yfa wn[nl.wpy pyriwjsj q m Sp,pop t»vm4upn px qer tawrlulena m puelk R para.. ..
<br /> �rF•T 1, ' �!h,� w y1,4�'L'� 't ,.,a i'•.ciY' 3 'i'i n�i +¢.-r 1�"yf .... � .ivi� ��� 3 � � 4i'��r c 1,.7 ,
<br /> �..a�-�illd�'s;N" H_ t u..;r�t�. �,�,r+�.,„,r�s_a•�.�z�;m,�fr,..,,t.c..:.� .�rDtrty a�n',@E��@.s._:r., ,,.:,t__ ",,,•*Katie �. .>:
<br /> 30 8 6 5 9 C 0hiclrup Delivery< � `• l J I
<br /> I_ IJ..�..L
<br /> Hauler Tir�'Piagra ID"7, site suffix Facility-Teleph6n"e Number
<br /> Y aC t LbW0, U
<br /> _o
<br /> �'' *� � ��Yd+nwdyht.hrTbns. Facility Business
<br /> Name/Address
<br /> H_%uler Telephone Number ; CIty,State and Zip
<br /> Starrlp or Label OK
<br /> ap
<br /> '�"� - • Y,I. Only '- I CERTFY THAT UNOEA PENALTY OF PERJURY OF TNI
<br /> T _ - - - _ I � Wti�ta,�ro�^^_„_• '-^"�'J-++� -LAWS OF THE STATE OF CAUFORKA THAT THE
<br /> - _ RNATION •MM
<br /> Comprehensive TrE Log Number •.• InforiflationProgram
<br /> •ifi n
<br /> F ' R ®3086159 °
<br /> Hauler Tire Program ID I Site suffixFacility Telephone Number
<br /> DATE_. y .a
<br /> �R OWhole Trre Coun!, Welehtln Lbs
<br /> __ _. .. �Facility Business;� �Q y��cCK' C rq1
<br /> o '❑_Volume.Cubic Yds. . Welp In Togo: NamelAddress Etat
<br /> CI State and ZIP��$�� 1
<br /> HaulerTAtephorieTfumbe�` tY
<br /> Stamp or Label OK
<br /> �irpa Only I CERTIFY THAT UN r AiTT of reruuRY of THE
<br /> ••`••fOr WhOIB TIre:Cqunf' .LAWS OF THE STATE OF CALIFURtSA TNAT'i11I„
<br /> "INF TIUN VIDEO A UE ORRECT.
<br /> Comprehensive
<br /> Delivery. ,. ME •-
<br /> Hauler The Program ID I'Site suffix DATE.
<br /> Facility Telephone Number
<br /> ©_/!,. 1© ynn
<br /> .. �11V4� �C�► .' ?I91ttIQ►�-�IEi�.
<br /> �. Facility Business :! -r6C n
<br /> k .O
<br /> lull- � -► is da Wei9ht;VLT911im Name/Address
<br /> -Hauler T ephone•Numlier:� .. _.4_. w_.. ...s ,. ._ ..�_. y.d. x. tb and Zip 'C
<br /> . � Stamp�or Label OK p'� \�
<br /> T
<br /> S^e .•.C"_� ,.,�:r,�• �,,.�--�,:p � .r_� p�IF .. T•. EMALTK ..PIRHIRY-OF THE -e-
<br /> _
<br /> _- .. ..• -. ... -L'AW!OF 7N!STATE OF CALIFORNIA TINT THE”
<br /> r�
<br /> ...forrWhP5F9`TICount--- ..
<br />
|