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VJ <br />Calttomla IMtgmteA Weste MeiweeMent Board <br />•••• CA Comprehensive Trip Log and Receipts 100.02' P.O.BOa126e,Sacm111enf0,CA 96612_ 1259 <br />-E X 'A M P L 'E 1 2 ,3 Com rehensive Trip Number <br />INSTRUCTIONS ON BACK OF PART -2 .DO NOT TAPE.,STAPLE OR DUPLICATE ? 4 5 2 0 4 <br />er flpnhO Nla CA C.mpr.M -TnP W .nd RMaipl,-IMJkaNrtfl nquen uoe ar IMamr.nen w�afla.Ma m N• I. Idm� n b. mslG•nA Conatl•MI•I- <br />1]001 M pmpMary •np a.G s.anL In •eMrd.,,c. FAN TIO$, t• CCR, 6•ellm <br />ffR.N•rfpufstbnuW bdbdo•un al ptlf utiermiltaM1 <br />TrucDecal Number Hauler Address F crD C11r <br />HkM Business Name <br />Address J <br />City, State and Zip cj -�Vo I' f-0 / -q-5 q / _ <br />License Plate Number State �j/` v <br />1. H 19®®©® ®a 0 Cameron <br />. - I =Mfy uww mnoy of PF" uMw pie bws of IN stete.1 CfObn4 U M pro Itdatm.Uan proNtled a.ore b true end Conan In edditlon. � em ewm. MW rebM-I'M <br />- al nib hf—.U. may —ft In wip.n . mo 111 , m d.nb1.1 Nnewal of w <br />Wesb Tim Heubr Rapbtr•Ilon putw.M b PutMc Rnavme Calf .Mbn.2aE0 end mOY mwn h alrn Oa RJn W b $ 25.000 per dfy, per vldsdm a adMN Mw pawbb. up to $5.000 Pfr,-I.W%n p•r day w d—bW In PubOc Rsawnas <br />Cade sec9pn;; 03062070018 >4 <br />3745204 Be. C <br />Hauler Tire Program ID / Site S <br />E o-;1131:71.—1 <br />.o Hauler Name ' <br />Hauler Telephone Number <br />. XM- I1�''- <br />,Pi'ck Up U D live?J, <br />uff DATE U JP I/ hjll !? IO <br />/ I <br />WholwTIre JLb.. <br />Vo u uYloX -B eighVV t In Ton. <br />i <br />FrG oaoaa.a6 <br />IN /A for <br />Whole Tiros) <br />�I fr7E�I�fsl�1T� <br />Facility Business . /)2�')s [Jho G ZR� <br />Name/Address �' ,� <br />City, State and Zip [II[ <br />7CMrasn.n..1. eisnl !ll(Vs•'T�kToN � • /� - - <br />'EM YOFTHE <br />THAT THE <br />L;Omprenensive 1 rip Log Aumber Load Intormation Facility Tire Program ID. Site Suf <br />EBB <br />37452.04 •• .8; ti Pickup Delivery <br />Hauler Tire Program ID / sit7Suffix Facility Telephone Number • . <br />d / DATE <br />} ? l d U) Whole Tire Count0 Weight in Lbs. <br />©a a - ME) HO E Ho <br />Facility Business <br />E 3 � O 1 + Volume Cubic Yds. ❑ Weight In Tons Name/Address v/. <br />E <br />Hauler Nam Q/ City, State and Zip 67 00 /t/�RW�'I <br />gOD �15/ /�ll�il� , S. asooROHEStamp or Label OK �C4aw1�U/C •4175,9HaulerTelephone Number y.0 Address Same as Haulers <br />2 (/�{ IN /A for I CERTIFY THAT UNDER PENALTY OF PEIUUIIY OF THE r <br />(moi �� — WIIOIY TUBE) • uWD OF i1R STATE OF CAIIFORNI►TNA7 THE �••/0i <br />INFORMATION OVIDED ABOVE <br />5 TRUE ANO CORRECT. <br />3745204 " A Pick Up <br />g � Delivery <br />' Hauler Tire Program ID / Slte Suffix n <br />DATE a�f ®® / D® <br />t <br />W wA Whole Tire Count O Weight in Lbs. <br />icAW37i oil <br />fL <br />aVolume Cubic Yds. Weight in Tons <br />E Hauler Name R� r trL <br />ci rT u��ir a� �I �a•�� <br />Hauler Telephone NNumber <br />I U - �� g - 9543 (14 IA <br />Whole I hole for <br />Thea) <br />M . OE-EMEOMPP <br />Faculty Business(J.S <br />Name/Address 6'l /6 FAA IAVAI <br />City, State and Zip <br />%P #C <br />16 <br />Stamp or Label OK ��e� M�#P-, <br />Ej Address Same HaulerE <br />I CERTIFY THAT UNDER PENALTY Of PERJURY OF THE � <br />LAMS OF THE STATE OF CALIFORNIA TWAT THE r / <br />