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CComprehensive Trip Log Number Load Information Fac;';*y Tire Program ID Site S ffix <br /> Q <br /> C-- Pick Up Delivery <br /> 3 2 6 2 9 8 6 <br /> d Hauler Tire Program ID / Site Suffix Facility Telephone Number <br /> 9 DATE �0],W <br /> 'f © / ©� _ <br /> It <br /> Whole ireti�pugt E]Weight in Lbs. <br /> s ajb, <br /> ,l t`rd t l , -;r ;10r1f1rfA-1iJ i,` Facility Business sf��. <br /> 2i 2. z ( Volume Cubic Yds.❑Weight in To�s Name/Address 3 Z �'S n�M'r RD <br /> ,i ::w!•i ,!� , ' <br /> E City, State and Zip slocA o.— C14,9S <br /> ya o Hauler Name <br /> ft2C 4AOUOR ANO PC-C,4 � / /) � _ '' ._'tamp or Label OK <br /> ❑Hauler Telephone Number a (,1 ■ — Address Same as Hauler Mitiais <br /> (N IA for I CERTIFY THAT UNDER PENALTY OF PERJURY OF THE <br /> 2aq) �3 t _S�/// Whole TIfBS) LAWS OF THE STATE OF CALIFORNIA THAT THE <br /> \ INFORMATION PROVIDED ABOVE IS TRUE AND CORRECT. <br /> __G <br />