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• 06134.of Ra.ouroa.Racycllna and Racovary <br /> CA Comprehensive Trip Log and Receipts 10002 P.O.Bon 1259,SacrartHirttD,CA95012-1250 <br /> C8jReCVd8j.EjXjAjMFPjLjEj 1112F3 Com rehensgiiv�eq Tri Number <br /> �d„, °� yv`� <br /> 4INSTRUCTIONS ON BACK OF PART 2 PO NOT TApb STAPLE OR DUPLICATE `� 5 4 <br /> By rloninp tWe CA CompnArnaMa My Lep end Recolpl,the alpnwfal rapwat that the H.—aUon poAded-thla lam w9 be oonaid—d corlidamial,proplalary arta trade aecnt In e000rdltrtca vflth Tkw,14 CCR.Beod n <br /> lTD41 e1 eery.It a rao"W IS meds for dlacics—of tNe Irrortnatlon,Ceoiaoyola will contact the elpa.rlal of INS form at the addraea and tt4pfwru raunb.p,-w d an thl.town a faeetpc <br /> ehlcle I f rition <br /> Truck Decal Number Hauler Address (,'� <br /> _ Business Name l! f U, nOn \N r-e- <br /> Address 3Do �. Wt 15o,, tNc <br /> License Plate Number LJ ( State CI��State and Zip c`—�� <br /> Common `��}un CA. ��2( <br /> Carrier J <br /> I oeNy urf}M P.,•elry d oerlt.ry arta ih a lave d lha State of Caplan4 tnu da IMormat:on pnovkfed.eova 4 7—end correct.In addltlan,I am Swan that fi"Aoatton of tna allonnatlon may ratult In Weperslon,raven lion,o,daffy of r r,—w of <br /> the Waata Thi ttau4r I tbn paraua,rt b PUbllc Raecucaa cod pFtbn a2.00 and may—4 h am penal&.up to S 46.000 pe,day,pa,Vk l taon M odr,".Iralire pa"dl lea 4p to&6.000 per vb�aUon <br /> Cod Seam ago pe,(I u daecrlbed M P. Raanuc_ <br /> Driver's Name rin Driver's SI nature Dat <br /> Compreliensivo Trip Log Number Load Information <br /> 4 8 4 8 4 5 4 =" C Pick Up f,Delivea aETH <br /> _PF <br /> U <br /> Hauler Tire Program Ip / '•Site Suffix Tele hone Number <br /> DATEofffacility <br /> pMp ao <br /> a Wholo.Tiro Count Weight In Lbs: <br /> Facility Business <br /> EIJ (j \-j" 9 ... 0 ` 0 VOIUMO CubiC Yds. Weight In Tons Name/Address <br /> 0 Hauler Name City,State and Zip <br /> U TJX Cri Stamp or Label OK <br /> auler Telephone Number VJ ■ Address Same as Hauler <br /> (� {N/A for I CERTIFY THAT UNDER PENALTY OF PERJURY O'F' <br /> THH <br /> 2 C� p 1 Wtlofa Tlra&) LAWS OF TNe STATE OF CALIFORNIA TNAS THa <br /> INFORI&A1TON PROVIDED A q TRU!ANDCORRHC'& <br /> Comprehensive • • . Information <br /> n <br /> 4848454 8 Pick Up Delivery _ <br /> U <br /> Hauler Tire program ID / Site Suffix Facility Tele hone Number <br /> 0[] / []� , Flo <br /> p <br /> � w E]Whole Tire Count 0 Weight In Lbs. <br /> Soo- ooaaooa <br /> Facility Business <br /> a� Volume Cubic Yds. ❑ Weight in Ton's Name/Address <br /> E .Hauler Name City,State and Zip <br /> U Stamp or Label OK <br /> Hauler Telephone Number • i � Address Same,as Hauler, <br /> (N/A for I CERTIFY THAT UNDER PENALTY Of PERJURY OF TH6 <br /> Whola Tiro.) LAW OF THE STATE OF CALOORmA THAT THE . <br /> S/FORNATgN PR04pED AOOVE K TRUE AND CORRECT, <br /> Comprehensive •a Number • InformationFacility Tire Program <br /> a <br /> 4848454 -- A Pick UpT7 V 0 N H-0,Delivery 4 - j } <br /> U <br /> a <br /> Hauler Tire Program ID / Site Suffix Facility Telephone Number . <br /> N DATE <br /> Soo- ooaoo� <br /> CL <br /> fWhole Tire Count Might In Lbs. \ <br /> 1 fi �cility Business <br /> ( <br /> �i U / aa_ lV I Volume Cubic Yds. Weight In Tons i /!Zddress <br /> E Saler NameQt�aa �M 1 <br /> Hauler Telephone Number ■ Address Same as Hauler ! <br /> RIS <br /> (WA for I CERTIFY THAT UNDER PENALTY OF PERJURY OF THE 1 <br /> Wholo Tiros) LAWS OF THE STATE OF CAUFORNU THAT THC / <br /> INFORMATION PROVIDED ABOVE Is TRUE AND CORRECT. <br />