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•- - Dept.of Resources Recycling and Recovery CA Comprehensive Trip Log and Receipts 10002 P.O.Box 1259,Sacramento,CA 95812.1259 Ca1ReCyCj8EXAMPLEj-- 1112131 Comprehensive Trip Number e'vift+omrilio)INSTRUCTIONS ON BACK OF PART 2 DO NOT TAPE,STAPLE Ott (DUPLICATE 4 2 8 4 3 8 By signing this CA ComPMMrolr•Tip Lop and ReCslpt the slpn•r(s)-quest that the Information provided on thla torn will bs considered confidential,proprlsferyand trade worst In accordance wxh TIUe,14 CCR,Section 17041 at see.,H a request is made for discb•ur•of this hdormetion.Csrflerycls will cantso the algnsr(ei of this toren at the add-ss and telephone number provided on thts lam or receipt VehiCle Informatlon ._' Truck Decal Number Hauler Address F Business Name h JOUl✓1 (1(1/07111 I'lD✓19 4h6 Address 60rrs City,Siete and Zip �� 2130-3,0 License Plate Number- '.,i;t ; ..,-: State � � � ,000 -7 EHMMEM01i , Carrier I certify under penalty of perury under the laws of the State of Callfornia that the information provided above is true and correct.to addition, aware that f aiTkellon c his intoT tion maII in Luapensim,revocation,or denial of renewal of the Waste Tim He Repbtralion pursuant tp Publb Resources Coda eectIo 42960 and may result In c v penattiea up to S 26,000 per day,per ' laden or miniatrative altle p toI.f,u pa violetbn per day as described In PubA ResourcesCode aeCtlpn 42902Q \`!Y\h 11 � Driver's Name ring Driver's Signature Date • • • • • •• •. • • • Program 4284389 -- C Pick Up 'Delivery. a DEE - E Hauler Tire-Program ID '/ Site Suffix 'DATE D / as , Facility Telephone Number ora Whole Tire Count Weight in Lbs. ooa -ooa000a . f=acility E3usiness ... 0 Volume Cubic Yds. ❑ Weight in Tons Name/Address E Hauler Name City,State and Zip w 3 Stamp or Label OK Hauler Telephone Number OEOEDMOE. E] Address Same as Hauler (N/A for I CERTIFY THAT UNDER PENALTY OF PERJURY OF THE Whole Tires) LAWS OF THE STATE OF CALIFORNIA THAT THE INFORMATION PROVIDED ABOVE IS TRUE AHD CORRECT. �>r x 4284389 ■- B Pick Up Delivery - ® a Hauler Tire Proram ID / Site.�S,uffix Facility Telephone Number � Cl�✓I erVjr�I�a DATE [dE / �.� ?A213D3DI ORE-oo © oa ® ® P f GW CfsZl 3 a ®Whole Tire Count E] Weight in Lbs.. q -,;w � —Faci" y ++�r''-s�7�(ovP (�f�S.T r7l 2 j Q , E]Volume Cubic Yds. ❑ Weight in Tons Na lt_a K E City��fii 1rpc�Osf G Hauler Name "T 3 � ►uy1D4,11 aal-eki C,r a Stalin 4��i n,Gki q�2Ob Hauler Telephone Number 000ug-MDE F-1 Address Same as Hauler , rr ?/� 1 '" r R 2 r• z,l v O WhN/A for ole rues) I CERTIFY THAT UNDER PENALTY OF PERJURY OF THE LAW OF THE=CALIFORNIA CALIFORNIA THAT THE INfORMATIOH PROVIOEO ABOVE IS TRUE AND CORRECT. Comprehensive Trip Log Number Load Information Facility Tire Program ID Site Suffix a 4284389 -- AEE -Pick Up 71Delivery HF A R R—N Hauler Tire Program ID / Site uffix Facility Telephone Number g DATE EE er 1 c �,(�•, �jQx 2 I 3 w ® Whole Tire Count E]Might in Lbs. tVArc11�fX- � � Faar�t,'iy_�[�ri,7't�"+nesph� �� r 7 ) 2 ( o Volume Cubic Yds. Weight in Tons Nar ;H:lr3ss / c Hauler-Name J (DNSe a fi� Imo. C i�tt�fa ��, VHauler k51ti , . /0S ! Stam�v�&Ile Telephone Number r MED F-1 Address Same as Hauler ln/tf fs 2 O ^� (N/A for i CERTIFY THAT TAT ER PENALTY PERJURYE THE (1 Whole Tire*) LAWS OF THE STATE OF CALIFORNIANTHAT THE (fill, INFORMATION PROVIDED ABOVE 13 TRUE AND CORRECT.