Laserfiche WebLink
'Pt.of Rebourcea R•cycDng and Recovery <br /> CA Comprehensive Trip Log and Receipts . 10002 P.O:Box 12.59,Sacramento,CA OW12-1259. <br /> CMM:Vae x a M 1 L E Com ensiwe Tri Number <br /> Sud orCehbrrW <br /> rawKTewm"v INSTRUCTIONS ON BACK OF PART 2..DO NOT TAPE,STAPLE OR DUPLICATE . <br /> By eig."this CA Compml I. TMP Lee fwd Ro.Pf.".bnwrIN regMM eve the kdor Uon proOded en al.roan wi•a cautdwed con5dontm,propnewry and Vad...ei.L In.ocordence with TMG,f,OCR,Section. ., .. <br /> 17041 at sect.,N a newt M made for d4Uoeus of If"lydorriwtkm CaMocyde W contact the sigimpI.1 of thM t—.n the wicks and trleplwrr nu bed podded on ft.form or n ipt - •.. <br /> of�? .. a •�: �.Vehlci'11nTormatlon '.;;r r 'r., , <br /> Truck Decal Number Hauler Address (� <br /> Business Name �J GLIM jwq U I h �?qwo �n Set v4�7 <br /> 4 <br /> i Address r PS <br /> . <br /> License Plate Number slate City, State and Zip v <br /> x �0 3G <br /> L 'Common ��O a 21. J <br /> ❑ a ® ❑ ® aa © aCarrier IvC <br /> .. I c.My utas pwra•y of Perry ruder fro Meds of ere that.d Callanra trot ih.ydormMJon providedabove a we ua owrwl.1n.ddnbn.I=•wwo Nn hWSvucn of me tdamaUwt rowA in.uap.ekn6 nroc.tkn,or dwM of Mr w.l of <br /> O <br /> IM Wuta Tim HauMr R. MIon pu.u•nI to f tk Rowources Code swtoi42890 wid may wA y1 civil pwWues up to$25,000 per dry,per or M up to$5, ton pw day u dwalbed In Public Raaoucn <br /> Driver's Name.(Drint). - river's Si nature.• Date,Comprehensive Trip Log Number Load Information Facility Tire Program ID Site Suffix- <br /> :•; <br /> a5.5.9:8:8 Pick uP Delivery ❑ ❑ ❑ ❑ ❑ ❑ ❑- <br /> - Facility Telephone Number <br /> Hauier Tire Program ID-•! Site,Suffix .DATE a % DE <br /> / <br /> U61 Whole Tire count ❑ Wefght in Lbs. <br /> Facility Business . <br /> Volume Cubic Yds. ❑Weight in Tons Name/Address <br /> Hauler Name _ City,State avid Zip <br /> • V <br /> Stamp or Label OK <br /> Hauler Telephone Number ■ ❑ Address Same as Hauler nRraa <br /> (N/A for f CERTIFY THAT UNDER PENALTY OF PERJURY OF THE t <br /> Whole Tire•i LAWS OF THE STATE OP CALIFORNIA THAT THE! i / <br /> NFORMATWN PROVDEO ABOVE IS TRUE AMD CORRECT. <br /> Comprehensive Trip Log Number Load Information Facility Tire Program ID Site Suffix <br /> , <br /> 5598859 ea— B Pick Up Delivery' <br /> mFacility Telephone Number ' <br /> Q Hauler Tire Program 1' Site Suffix DATE <br /> Rb <br /> ` w Whole Tire Count Weight in Lbs. ,� ! <br /> 4012-1 t� p Volume tibidYds. ❑Weight in Tons •M ri�?FI:Dress <br /> mlC <br /> cer- (Y'i• l(k lL�_I Crr�I�6"Td G/►�'�pr(�rGtU - -1 = <br /> v ;1 �LC•1"lUv► r r-ISS . � <br /> U00EA, <br /> •�• �• stal�,p�►ifL�a�'u�( l/+'►- , t .x,20 <br /> _ a <br /> -Hauler Telephope.Number _ _ • a :Address Same as_Hauler-- n <br /> /�� •\ (NDA for- :.I CfeRTFY THA?UNDER PENALTY OF PERJURY OF THE �. .4 <br /> .`/ f!"►-�,,.�• �/ X 1 WV oIS Tb*s) 'LAYYS OF THE STATE OF CAI.IFORNN THAT THE - •+ _ •k' <br /> L�/ •.S.it "••��4Vt�•, MFOMIAT101/PROV WED ABOVE 0 TRUE AND CORRECT <br /> Y' . <br /> Comprehensive Trip Log Number Load Information Facility Tire Program <br /> .5598859' -- A X _M M..'. H*Fri - <br /> Pick Up Delivery MMM ©. <br /> HaITire ram ID; / Site Suffix DATE a� / aD , ❑® Facility Telephone Number <br /> Ir <br /> 0- lox zr 3� _- goo=© aooa ® a : <br /> w ® Whole Tire Count Weight In Lbs. <br /> � � �lqu.i'7�f� 11:I►u rl.UiS�i I <br /> 7 2 I �� Volume Cubic Yds. Weight in Tons Nar- A r Ss <br /> - E I r - Citp�• e l�`iLf n?A f I� - <br /> � 14 Mel 11��1anC� 1 11 +1�EDDEEMEE <br /> sttiwtxa-R-hfit ttttAic G)�3Hauler Telephone Number Address Same as Hauler nNMf <br /> /i J1� <br /> (M/A in LAWS FY THAT UNDER PENALTY PERJURY OF THE <br /> L/f1 L �r Whole Tints) LAWS OF THE STATE OF CALIFORNIA111THAT THE <br /> NFORMAMON PROVIDED ABOVE 13 TRUE AND CORRECT <br />