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Comprehensive Trip •• NumberLoad Information Fa cility Tire <br /> Program D Site Suffix <br /> 4 8 <br /> 88958 -- A ' Pick Up ❑ Delivery <br /> Hauler Tire Program ID / Site Suffix Facility Telephone Number <br /> DATE O 9E <br /> , <br /> 1 <br /> 9 <br /> 12 — -� E <br /> – Eupn <br /> M a N Whole Tire Count [] Weight in lbs. <br /> IL IlQ j I` j I E] Volume Cubic Yds. n Weight in Tons <br /> o '?auler Name <br /> 'nu!erTelephonr, !troll`^t Q ■ - <br /> 1_ .iFtS I�CiGL^.i' Initials <br /> C-113� '7L I�i Y iNi A!or I CERTIFY THAT UNDER PENALTY OF PERJURYOF M <br /> Whole Tiros) LAWS OF THE STATE OF CALIFORNUIT"ATTHE <br /> INFORMATION PROVIDED ABOVE IS TRUE AND CORRECT. <br />