.Toll Free 1=136U-89G-U6UUT`vfWjiW.CliifTffny-;- "Ka' 7_ –
<br /> :
<br /> C4114501"I* rtegrRbdYJAEtdMunayulrlwltw:AnT
<br /> CA Com rehensive Trip Loy and Receipts 10002 1110 rlo41259.8•c--rft,CA xu-use
<br /> X J+ l."I P l �� i , . � Comprehensive Trip Nt�rribrr
<br /> rata t
<br /> C.IA.Sl97@1�W�{I
<br /> INSTRUCTIONS ON BACK OF PART 2 DQ NOT TAPE,. APLE OR DUPLICATE
<br /> 48-122
<br /> uy dnao-.a u,a r4 raerr.t,nxrm P11.1a 1—R 1,d,[I.hlDu•11.111•v"a ulal n»haxrm,+.r.,Pn,a,dl.l au Itd.krr„Mll 1--ldaad cnM,LIutl011F OPrNurl d h.•dx w,r,l. is e.,...dr.•.,wi,Il:4,t1 r.C,r..i-_u:.,,
<br /> _ rcI ,i r,y rn mquwibn,mna-r::.v Iau nr ar r*I.bdxxuMtnu,fUaCt1y"wtll cK+,..rII Ih,.lynar(yath•,U„m•I Ile addnxund Mlxld,xoa Iwmlwr Wnv.dw m.meInrm or„aafIn
<br /> y Hauler Address
<br /> TI.J,k.[,ua d IJurt!11:11 I u /• 1 '
<br /> Buslrless Name rt F? _ �'� +., C•' Ir,, ! k ,ti 1(`11.1,I ..
<br /> Address
<br /> t-
<br /> 1111 r t
<br /> Gity, 5tato and 1 ip i y
<br /> �1. Il t�'.(1II jIft"'�I''�1I�IItf``71"i�AII( . r11E'.
<br /> t_J l_J LJ a' 1 Gatttrtlun L �I; 't,�Ls? I I?._ I I
<br /> I—,u+da:«rally A Pw,u•r n,w,•IIx 1 111 Fu t11nU,A:Jlu•Iw NW h /h •Na,I.nuli«I d;a•a p 1't,s u r�ntt.Y Odrl�a.l sl x I-nl qld r..tkxt al drU YIOrrOl1{�`Irwr+rlfl 1,rUlpsrO'•ro•+.ali,a JI.1J rl lx r,xul.1 t.
<br /> Ylwb Pm00w l41u 51.1"11--b"Ayr lir dar ati d—V d h r+-Jd,tiv.
<br /> C I
<br /> Driver+s Name prim Driver's Signatitro fJato
<br /> Comprehensive • Log Number Load InformationFacility Tire Program ID Site Suffi
<br /> ti 3248722
<br /> ED 0 0 on
<br /> -0 u
<br /> l Facility Talo hone Number
<br /> �' Hauler Tire Program ID t Site Suffix ' �'�r '-+ > „ Y P
<br /> )Ij
<br /> �IJJ�`C m j!
<br /> . : •� :Q 61,...5{ -'. '� < 4 Y,j`—?{' F.
<br /> a
<br /> Hall or t�.;nrn
<br /> 11111. � i
<br /> 43 I
<br /> h r
<br /> p1:,11t,>r el»pirtl,v.:Rltirr, "' "1 L I I�IJdre_..a rrt(
<br /> c a:. FLIuI•I near, -
<br /> i
<br /> 1 , - =;; "Q .s'>}.p ..«N} ';?� '&'y E s � IEIFMPY TPAT UNDER PEINILTYIIPRN1nNY!,1 ri I
<br /> IAwi OF T.1E uTAVE0,"01711AT ldh
<br /> r 11.11. rritD� d IrIrinlrrATlnn PP,v:
<br /> o rannr.
<br /> ;Comprehensive Trip r . ..• Information, Program
<br /> a 3248722 0 acMCA, t 4 DO H
<br /> yHauloi Tirn Pruyrarn ID 1 Site Suffix Facility Telephone Number
<br /> 4 ;I 0/1 + I • �tlr�r� G_
<br /> Pn. ii-mi(tt raiophane Number F] Addross• aH14 a5 Hkiler rrmwig
<br /> J _ r CENTIIY 11/ATu110LA PEN••tv a rCULM al INl
<br /> +'xy 't {, _ /•r r+ ,I Win Gr•till,STATE nr CALIFDH14U TIIAT Tllr
<br /> 1 vol Nta0ltx A9p••E 11 r E AN:1Comprehensive Trip Log.Number S'T91/ONCI.
<br /> IM
<br /> •0 /
<br /> 3248722 .t , a a a a a
<br /> `+ z,
<br /> Hauler Tier Program 10 Site Suffix - 111(�y'''}I11 Facility Telt}Phone Number
<br /> t1�� I:•. Y ds`� � �:. I i „11 �J � '' ~�� '''�"`�III l,I
<br /> I 1.I i..I I'r-•hr_ s .i .��� 1 !?�Ih+ ^_4 r;°'"•t•i - .Jf f.
<br /> <: i.Tulel Ielc:phonn NrrrriNtr I II I/oaf+r.t.ss vaisre as Mather
<br /> � t I .l rr,aad.
<br /> I A IIrPY OKI`UNMR PENALTY ar PEN,uNY Ct 1hE
<br /> ,•�` } t r vv I AN7 nr THE 11111M 1Y.CAL r'CNN,A 111A1 1111
<br /> :. + c 3,: rlul+tlnnnN PM.7Yacu Anuy I NI Aon CudleMtr. Itr.
<br />
|