COMPLIANCE INFO - Laserfiche WebLink

Home Browse Search

c"".1e Integrated Waste Management Board CA Comprehensive Trip Log and Receipts 10002 P.O.BO.1259,5acrameItIjr asa,B-,YSg Efx Aipn P L E I 2 3 Com rehensiveTri Number envae"ioaj,g,u)INSTRUCTIONS ON BACK OF PART 2 DO NOT TAPE,STAPLE OR DUPLICATE -3.620138 By Ngning Nla CA Comprehensive Trip Log and Repand, pr Ob Mgnerts)rnat Orotiprovd•d Mt OInformation lon Nb twrn vdll Ib rurad coldeeon6donllal,pmpd—y and rw ids er. N eIn"—lanes MTIft 14 CCR,Seetlon ..17041 of sap..O s regrwat Is mode for dlaoloeure of WnfomMeon I ,Ne CIWla MII confect the Mgner(•)of N4 fwm u tho sddr••s and miapnons number provided on Ws tamr or recolp,. a'C e]nto`rmet On Hauler Address Truck Decal Number Business Name Les Schwab Warehouse Centers H — HERVIR ® Address 646 NNV Madras Highway City,State and Zip . PruneviDe, OR 97754 License Plate Number State © � ® © ©�.a D® ❑ rr" Carrier 1 cwllfy under penalty of perjury uMw Ne lewc at the Sle[o of C•lilwnu Inst Ne IiHom+aUon prvNded above Is tine and caned.In eddWon.l am aware Nat famapauon of Nla irdo adm may result In susq' atop ravomaon.or demal of renewal of f V Waste Tiro Hauler ReglstraUon pureueM N Public Resoincea Cada seUlon 42fifi0 end may—Al In tiv0 perelUes up b 111,100 per d,,gar viola0on w etlminbtretiva partakes u�11,011 per violation ior, deswibetl in Publk Resourua Coda 42962 river's Name(print) Driver's Signature - Date �� ProgramComprehensive Trip Log Number Load Information Facility Tire ni . Q -_=r... n Io:A.�' r•, rte.r►a.r:a :.�a. n ❑ ❑ ❑ ❑nen n n JLGVIJ V •a.••.n U vcurcFY Li Li Li Li Lj Li Li Hauler Tire Program ID'/'"'Site-Suffix' Facility Telephone Number m a Whole Tiie l cunt: Weight in Lbs: Fcility Business L e,5 SC,)---ab a EQ. ❑l Volume Cubic Yds.a Weight in Tons Name/Address 1 9`3� �. lN,Y Av'C o Hauler Name City,State and Zip A9U y U LeulerhWph Q.❑❑❑❑1 21 © Stamp or Label sSam . Hauler Telephone Number 14\�I■ Address Same.as Hauler )no;l, (N/A.IOr I CERRFY THAT UNDER PENALTY OF PEAJURY OF THE 1-541-4.47-4136 - _ _ Whole nres) .;;LAWS ORY°AFTb.PqO m°EB`,CALIFORNIA tlE AN Comprehensive • Log Number Load Information Facility Tire Program ID Site Suffix .3620-138, -1 g : Pick Up - ❑' Deli ery ❑ ❑ ❑ ❑ ❑ ❑-❑ ❑ Hau er Tire Program ID / Site Suffix / /V1n Facl Telephone NumberDATE ❑I❑w'❑Who a Tire Count Wei ❑cility Bu ness 1 0.,0•.2 8 �4l 2 . — 1., ^O V lu!"e Cubic Yds. Weirite/ ' rags - io „Hauler:Namety' tate'end Les Schwab 1 ampor'Label OKHaulerTele hone: mbar , taAd dressSam_e,asHauler; miaara> -p77r'� l TIFY THAT UNDER PFlU�TY OFPE{UUPY OFTME 1-541441.-41 0F THE$TATE Or CAIJFDRNUI THAT THE.MATION PROVIDED ABOVE IS TRUE AND-CORRECT. V • • • •a •' • • • • - Program 3fi20138 -- A Pick Up Delivery © � ❑ —� Q Hauler Tire Program ID / Site Suffix n Facility Telephone Number DATE ®© / ❑Q/ ❑� q o ❑o-a®aa❑© � m w ®Whole Tire Count [:]Weight In Lbs. Facility Business W C-S i-S}C!Y 1 1)."rt2 -Wol 0 12 16'14 12 1 1011 E]Volume Cubic Yds.11 Weight in Tons Name/Address 1-74,3 kA r e k Hauler Name City,State and Zip L;txlt0 cr�QS236 Les Schwab a��❑❑❑ ❑❑ ❑ J t3 � Stamp or Label OK Hauler Telephone Number ■ Address Same as Hauler )nrBey 1-541-4 47-4136 IN/o TI UM OF THE STATE OF CALIFORNIATHAT THI CERTIFY THAT UKMR PENALTY OF PEA""""'E F THE Whole T1fBeJ INFORAIATION PROVIDED ABOVE 6 TRUE ANO CORRECT.