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CA Comprehensive Trip Log and Receipts • 10002 PABOX M.SWnMQ1ft.CAAO 12-1259 <br /> E x E A.M+, LIE t 2 i 3 <br /> Comprehensive Tri Number . <br /> �-- 3971057 <br /> . <br /> t:!V* INSTRUCTIONS ON BACK-,OF PART 2 DO.NOT TAPE.STAPLE OR DUPLICATE <br /> Bq arb CA CoerpraffermM•TAp L4rp end P*e*1M Ef•Mpratrp)r•atsra!Md em bdor mOm pow an trd•fo m•r10 be mrerMLw "ooakl•"M Oroprh4 Md tfad•"CM bt eCbarEssfcs%"M rft 14 fX,T_808 M - <br /> 170HMaq.te.•p+rubMade ffRd4ebamaloft taermatl%gocram WM*MfddVM6%M*)ambformMdf•s,ddr•s••n0tsdrpborwduafrb•rprovsd•donOft fosmarr•wtpt <br /> .e ele r rm on Hauler Address �("� � C�J �,, <br /> Truck Decal Number Business Name (-ga <br /> Address . kA C;�jC <br /> License Plate Number State City, State and Zip E <br /> ,Carr,Ier. L— <br /> t'oeMly uWer pend ty of pm)tay under me hove d the Stab of Cafdmda 11m1 oro kderrrmtion Provided above b bus and Coned.to add tion,1 orn aware emu hhMratWn of Me 6dfmmWn may msWt in suspension,ri�or detat of,tint al of In - <br /> r waste Tire Haufer.Repiswlbn PORMM to PLditReiouw Code section 42960 end mar Tp LM in dv0 penalties tq to f 25.000 per day:per vWition a a*.th btraAe pmmtdrs 0 to MOM per vidadon Per day as d,svtbod k NOW R•sovrc•a <br /> Code sedon 42062 <br /> 6 3 <br /> Drtvees'Name rant :Ditver's Sigriatdre `Date <br /> Comprehensive Trip .. Number Load InformationProgram <br /> It -.' Up Delivery' t <br /> o.oc -a.o:a aro <br /> Telephone Number <br /> ulerTlre:PragramlD I_ Site.gyW. DATE'e' � ~ <br /> EJ_ -_o_ ao�0000 <br /> W ole Tlrs Courrt -Weight in Lbs. <br /> F@cility Buslnasa. . <br /> EVolume Cubic Yds.[j Weight In Tons Morn'WAddress. <br /> $ Hauler Name ;City"State and Zip. ._ <br /> rj Stamp.or Label .. <br /> . , _J <br /> Hauler Telephone Number.' . :- c: ],Address,Seine as Hauler_._ <br /> cul-ray <br /> . •r (N/A for 1 CMM THAT tll(OBl FBi1LLTY0i F8iA02Y OF TLS:••(' --- '=: <br /> YY" ) LATE OF Tlr 8TATC OF GlIID10M TIMT THE <br /> .1 D•1iRlr AMD _ ' <br /> Comprehensive Trip Log Number Load Information Facility Tire Program ID Site Suffix—, <br /> .'3_971'G-5'_T- - B Pick , :neuvely <br /> CKHauler Tire Program•ID / Site suft O Facility Telephone Number .• . <br /> o DATE�� ®� aU <br /> LU Whole The Count We ht In Lbs. <br /> `Facility Business <br /> o 1 Volume Cubic.Yds. Weight in Tons ;EitA r• ' <br /> _ S -. � 0 Si�fA'AAROCK�RECYCLING:.•���•� <br /> aider amt - :,J 08.4�O�ALTGRNIA- INC• <br /> a• �:. r' b�6al09Vs Hautei . <br /> StddWRRIM CA. <br /> Hauler Telephone Number• _ - _ <br /> �•: - 7 - I eeLTvr.TwLi-utmei FeAL���T4��fir or nom`- t <br /> . .• .yy qrj��% IAMM OF TM STATE OF CMBW�w,TMTTIQ-S.. <br /> Comprehensive Trip Log Number Load Information •• 1 Site Suffix <br /> `a3 9 �1 fl 57. <br /> . PicAA-k�1p . •i 'Del <br /> 710U/ -d <br /> Hauler Tire Program-ID /• Site Suffltt. yFacillty.Telephone Number <br /> rDATE �® � f� <br /> m uv5Whole.Tirs count E1Welght in Llie. <br /> IE Factltty.Bustness <br /> 101 -- �� 0 Volume•Cublc.Yds. WelghtIn Tone • Name/Address <br /> E Ha or Name .. city,State and Zip <br /> d q2.3 <br /> _ - ,;� � Stamp or Label AK ' <br /> Hauler Telephone Number a . Address Same as Hauler <br /> f ' N,JA.rtif 1 aeao-r TfaT amts'PB&kL T aF PBUUW aF DM <br /> • •• -: ... t, lA�O TICr STATE O CAUFOM 1 TNA?TIM . <br /> LrC:::iYLn�:��ia•...�r.:<r.' '�'5 ..na..�..lilf TldlCf. <br />