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Nov 05 08 01 : 44p p. 3 <br /> -- yg �s.._ �f �a <br /> CA Cann reheriSrve '. L�Og � � �eCetp$S PQ 1311SacramellCA,958T2'-7259 <br /> .. Comprehensive Trips Number <br /> �I�� ��NOT TAPE STAPLE OR pUPLICAT ' 3086490 <br /> I. <br /> �;h�a�pdrd,.d5, INSTRUCTIONS ON BACK fl F <br /> By signing this CA Comprehensive Trip Log and Receipt,the signerts)request that the Information provided on this form will be considered confidential,propriotary and trade secret.to accordance Wqt Tile,IC CCR,Section <br /> 170 et sea.,;f a request Is made for disclosure of this information,the CIWMB will co.ract the sig nar(s1 of this farm at tho address and telephone number provided on this form or roceipi. <br /> Truck Decal Number ����� l/L/f�'j Ski �1 G� /il/��'� <br /> PO 2 7% <br /> ikeetse Plate Number State Adr as <br /> . J i'Fii�• <br /> I Pertik•under pena,ty of perjury under the laws of the State of California thal the information provided above is Ime and correct.In addition,!am e+vare Inal raisificavon of Mrs Info:malion may result in suspensia,rovooatlon,o•denml of ranewal of the <br /> V7asle Tire Hauler Regislmlian pursuant to Public Resources Code section 42SE0 antl may rosult in dvi:penalties up In S 25,000 per day.far violation nr admn atraeve pa 01bes up fo$5,0 0 per violation per day as Cesoribetl In?u�bfilc SResources <br /> Code section 42062 <br /> Driver's Name (print) Dr er's Signature Date <br /> Site,Suffix <br /> Comprehensive Trip .. Number Load Information Facility Tire Programr <br /> 3086490 -.. C Ll Pick Up DeliveryI LI 111111111111-11111 <br /> Facility Telephone Number <br /> m aHauler Tire Program Io ! Site Sufix <br /> DATE <br /> c 111 ( Whole Tire CountWeight in Lbs- <br /> � <br /> t— Volume Cubic Yds.DWeight in Togs lye e" C -ass <br /> City., State,a..,��r.p <br /> O <br /> 3 Hauler Telephone Number <br /> � <br /> Saarra.::�. "eahF eClK <br /> . <br /> � ! laltrals <br /> WWe Tires Only I CERTIFY THAT UNDER PENALn OF PERJURY OF THE <br /> LA.$OF THE STATE <br /> OF CALIFORNIA THAT THE <br /> for Whole Tire Count INFORMATION PROVIDED ABOVE IS TRUE AND CORRECT. <br /> Comprehensive <br /> Pick Up Q0i'very E 11-0 0 , <br /> 3086490 -� E11-10 0 0 0 <br /> m Facility Telephone.11707017- <br /> - umber <br /> U <br /> °i Hauler Tire Program fl) ( Site Suffix <br /> DATE ud j Whote Tre count. Weig*in Lbs. <br /> Q _ DoDODD <br /> R YFaci=°v"3trgirpacc - <br /> I-- Volume Cubic Yds. ii, tin Toms I <br /> Ci t�jr.State ar1d 7i^ <br /> E <br /> yHauler Telephone Number <br /> 3 Q St�„^p C, :.a b 0 01K <br /> U. <br /> Wt1dFe Tires Daly, [cLa •:HAT 111/7=_n vFNAL 7F 2-FLUR.Y Dr 7lN_ <br /> - JAWS OF iHE$TAT D`CkL3rG2'rba THAT T'!E <br /> COOIIx INFORINATVM PFtOWOEO ABOVE JF Tn'1JE nri0 CORR_Cr. <br /> Comprehensive Trc Log Number . .• Information Facility Tire Program <br /> Peck Up Qejfvet�t_ <br /> 3086490 _., �. .._� � <br /> mFacility Telephone Number <br /> Li <br /> Hauler Tire Prograrrtlls 1 Site Suix;x <br /> DATE- � ',f t Ll � � <br /> vu Whole Tire Count Weight in Lbs. �— <br /> [, E Vokum Cubic Yds.DWei ht iri'1 txis t u <br /> mry <br /> Q <br /> Hauler Teleahone F•tumbe.- <br /> L) - _ - c d ■. CI J .~ .r^f mit:a!s ,..e.r� <br /> Whole Tires Only p <br /> LAWS'31 7HE -H% 4f <br /> for Whole Tire Count re c f5N Pro � c s rv-IS TR =_AI v P <br /> �. +am.•rnaaavNow <br />