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Toll Free 1-866-896-0600 / www.calrecycle.ca.gov/Tires/ <br /> Dept,of Resources Recycling and Recovery <br /> CA Comprehensive Trip Log and Receipts 10002 P.O.Box 1259,Sacramento,CA 95812-1259 <br /> Co rehensive Tri Number <br /> CalRecycle EXAMPLE 1 2 3 4861829 <br /> $tee u1 C.NI—. <br /> unaYae203(711o)1NSTRUCTIONS ON BACK OF PART 2 DO NOT TAPS, STAPLE OR DUPLICAT <br /> By signing this CA Comprehensive Trip Log and Receipt,the signer(sl request that the information provided on this form will be considered confidential,proprietary am trade secret.In accordance with Title,14 CCR,Section <br /> 17041 at seq.,If a request Is made for disclosure of this information,Calft—ycle will contact the signer(s)of this form at the address and telephone number provided on this form or receipt. <br /> z f._.. � , ►�l�ror tfott liatFlr:r Addi-ess - Wholesale Equipment of Fresno <br /> Truck Decal Number rUSfrleSS�(�a11'ie <br /> Address <br /> n dba Wholesale IndListrial Pars <br /> 1/1 U Fol ® E E City,State and Zip 536 Display ,Jay <br /> License Plate Number State Sacramento, CA 95836 <br /> i ConinnonENRE H HE . Carrier l - <br /> cemfy under penalty of perjury-dar the laws of the State of California that the Information provided above is true and correct.In addition,I am aware that lalsifcation of this irformatior.may resu t io suspension,rev at,on,or denial of rerewal of <br /> the Waste Tire Hauler Registration pursuant to Public Resources Code section 42960 and may result in civil penalties up to$25,000 per day,per vio'.atlon or admi—tra penatt!es up to$5.000 per violation per day as described.n Public Resources <br /> Code section 42952 <br /> -Ver's Name(li" t) Driver's 'nature Date <br /> • .. Number Load Information Facility Tire Program <br /> a <br /> 4861829 -- C [:]Pick Up Delivery <br /> °o Facility Telephone Number <br /> Hauler Tire Program ID / Site Suffix DATE I(J ►1(, I 1 1 IU j ®111 b� II <br /> I�1� E P—RE H E EH E <br /> a Lu E Whole Tire Count Weight in Lbs. _ <br /> / Fy <br /> L' h tilts n ElVolume Cubic Yds. Weight in Tons <br /> oHauler Name o n G <br /> U G');�lac/ 40 0 D <br /> i <br /> ( i Awftlres:S as H- li ;ier Initials <br /> H a u 1 e rre I e p hone. N1,111tb <br /> JNIA for I CERTIFY THAT UNDER PENALTY OF PERJURY OF THE ,ey <br /> Whole Tires) LAWS OF THE STATE OF CAL FORNIA THAT THE <br /> INFORMATION PRONDED ABOVE IS TRUE AND CORRECT. <br /> Comprehensive Trip Log Num'Ler <br /> � . aooaooa-oo <br /> .. t_} -- B PFacility Tire Program ID Site Suff ix <br /> lck Up Delivery, <br /> 71 Es <br /> Facility Telephone Number <br /> - <br /> fy Hauler Tire Program ID / Site Suffix <br /> DATE <br /> a Whole Tire Count Welyht in Lbs. <br /> Dun- ooaaooa <br /> Volume Cubic Yds, E] Weight in Tons <br /> E <br /> p {-i <br />