COMPLIANCE INFO - Laserfiche WebLink

Home Browse Search

Dept.of Resources Re•cyoting and Recovery 02 CA Comprehensive Trip Log and Receipts 10002 R0.Box 1268,Sacrarnento,CA%812-1258 E3 Comprehensive Tri Number CalRscyclU XAMPLE 12 Gwxy�2L017111W INSTRUCTIONS ON BACK OF PART 2 DO NOT TAPE STAPLE Ott t7UPLICATE . 4845994 By algntng thla CA Ccmptsh•ndw nip Log and RecetpC the riWn•r(q regwel Ihat the Inlorm dlon provldsd on thts form W01 be considered confid•atial,prop letery end trade s•crM.In s--d—..With T/U.,14 CCR,Seaton 17041 of"q.,I e request It mads for dlaclesurs of this Information,CoiRecyole WHI contact ale elgner(a)of this form at en itis Add— d lsl•phons number provided m IN.form or r.p•Ipt. ' Vehicle Information Hauler Address Ftn `l Truck Decal Number Business Name 'J Address. Ucense Plate Number State City,State and Zip �� w r l•SQ� W� ® H L11 a NEW ❑ Carr eros �S t0 r- C� �.S ZG S J I ceet?y under penally of penury under the lave 01 the sta!a of Callomt 1f.t 1h4 nfor—bon provkled Above Is true and c—I.h add iic .I am ewers 11•et fefalhutVat of.ve olonno' 1 moy ro h ewpanalon,rsvocAtbn,or denial of nnewsl of the W0710 Tree Ha4a,Ro0'strWlon P ..A to Pubic Rosw—o3 Code ee<6on 42WJ mrd may result In dA p•nasles up to f 26,000 par day, Wo'arbn a adr,641'stly p•nas�•s to t5,0 vklstlon pa day ee deacrlbed In Pul6IA Resourcee Ccde eedlon::862' Ge -arrpta I��.: La .(.:ii 1 31,- i Driver's Name(Print Driver's Si nature Date Comprehensive Trip Log NUmber Load Information Facility Tire Program ID Sit e SLIffiX �r 4845994 '- C Pick Up-. Delivery. =� Hauler Tire Program ID / Site Suffix DATE / Facility Telephone Number M a Whole Tire Count Weight in Lbs. a ❑ a Doo ❑ aoo M Facility Business y ... Volume Cubic Yds. Weight In Tons Name/Addiess E Hauler Name City,State and Zip Stamp or Label OK ! Hauler Telephone,Number ■ ❑ Address Same as Hauler yrrudra (N/A for I CERTIFY THAT UNDER PENALTY OF PERJURY OF THE Whole Tiros) lA1YS OF T11E=CALIFORNIA CALIFORNIA THAT The INFi7RMAT1ge1 PRWDED ABOVE is TRUE AMO CORRECT. CL 1Comprehensive Trip Log Number •. • Information Facility Tire Prograrn ID Site Suff ix 9.7 4 5 9.9 4 -- B Pick Up Deliveryi (�,0 0 .Q ( _R,ire Program ID / Site Suffix Facility Telephone Number � DATEaa � oo � oo N Roo- oaoaa ®: ❑ Whole Tire Count 11 Welght in Lbs. 0p . Facility Businoss ' I Q I d Volume Cubic Ydsn. . a Weight in Tons Name/Address E Hauler Name City,State and Zip ; Stamp orLabel OK Hauler Telephone Number � ■ W Address Same as.,Haulei _ m rar I —J SP THAT AVETY OF PERJURY OF E Who•Tireal LAWS OF STAVE CALIFORNIAORNIA THAT THE GI l V� INFORMATION PRONOED ABOVE 13 TRUE AMD CORRECT. Comprehensive Trip Log •' • • Information •• 1 Site Suffix 4845994 -- APick,Up Delivery . G ❑ - Hauler Tire Program ID / Site Suffix Facility Telephone Number aoa � DATE �� / �� / aooao ® o M wd ® Whole Tire Count Weight In Lbs. 2 F(4� hiTVf�tir j,SGYV LCC {�6 C�/G I f Lt 1 1 0 I Q I1 1 9 q Volume Cubic Yds. Weight in Tons Fla eyAddress oHauler Name �I OQ:S4fzi�� Urq YN i t X Step orLabe0 95 G Hauler Telephone Number ■ Address Same as Hauler Nlar 2067 U6 (NLA for I CERTIFY THAT UNDER PENALTY OF PERJURY OF THe J CJ7 Whole TIma( LAWS OF THE STATE OF CALIFORNIA THAT THE INFORMATION PROVIDED ABOVE 13 TRUE AND CORRECT.