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Nov 05 08 01 : 45p p. 5 oard CA Cornpi" hq ,�7 California integrated ac Waste ,CA. 8T2-menr 725V If'IFeI�Stvc _p Log and RarC@fPts '�'�L„ P.O.P:a.BOX T259',Sacrarnento,cassan-zxsn ...r. t X,A ,M P;L I E' � ;3? --.- � OMPrehensive Trip Number I _ _ _ � s:vv ur:acbraM clf4afaxuilgwsl INSTRUCTIONS ON BACK OF PART 2 DO NOT TAPE,STAPLE OR DUPLICA Ed 334307 By signing this CA Comprenensiva Trip Log and Receipt,the sigrwr(sj request that the inioematl n prodded on this form will be considered oonbdenlist,proprietary and trade secret in accordance•.vitt.Tole,?4 CCR,Seetloo 17041 et Sao,H a request is made for disclosure of this informaflon,Um CIVaa1B will contact the sloner(s;of fhls form at the address and telephone number provided on this form or recolpt Y9EItCib iati i{ut3iL:/~f3Gi- frtrck Deca4 M1kf�rnber �.a C -j4i lddmss -'ll r State al'Sr17•rr., // `�, 1�j 2-7 Licenser P°fate I+Numbet State EIR I certify under penalty of pe)ury under the laws of the Stele of California that the imornloJon prodded aoove is uue and correct,In addition.I am aware that falsification of this infgtmabo—%U result in suaponslon,revocallon,or denial of renewal of the C.d.Wastel a Hauler Reglstracon pur�uan`t to Public Resources on 42960 and may result In uWl penalties❑p to$2.+`.000 Per day,ON v- —dministr per vlalskii per day 06 described In Public Resources Coda seOion<?Ba2rj� Driver's Name(print) Driver's Signature Date Comprehensive Trip Log Number Load Information Facility Tire Program ID Site suffix Es 3234307 CPi�k up ❑ Delivery.2� Lj E ❑ Ll ❑ U ❑ ❑-❑ 10 Hauler Tire Program ID / Site Sufirix00 / Facility Telephone Number � DATE ❑ ❑ ❑— ❑ ❑❑ ❑ � ❑ ua ZIL 11 Whole Tire Count Weight 1n Lbs. ❑ Volume Cubic Yds.❑Weight in Tons 7. o F:-.jl:ar Nvme N (N lA for I CERTIFY THAT UNDER PENALTY.OF PERJURY OF THE Whole Mi LAWS OF THE STATE OF CALIFORNIA THAT THE INFORMATION PROVIDED ABOv I E D CORRECT. Comprehensive Trip Log Number Load Information Facility Tire Program ID Si ? Suffix 3234307 B Pick Up I Delivery Hauler Tire Program ID ! Site Suffix DATE I f Facility Telephone Number m ©a oa ❑a /� �/ C� J Y a Whole Tire Count Weight in Lbs. !r / '(/ ZI ' .� ) ~ �lume Cubic Yds.❑Weight in Tons V N S 8 In/Hats IJ {'�l y f�1///,.,t^) (N to far I CERTIFY THAT UNDER PENALTY OF PERJURY OF THE /J/`7, S /si V v' W1101e Tired LAWS OF THE STATE of CALIFORNIA THAT THE /�� I INFORMATION PROVIDED ABOVE IS TRUE AND CORRECT, Comprehensive s •• Number Load • ♦ .s j: D Sid� 3234307' -a �. F - w ❑ ❑ ❑ Q ❑ ❑ ❑--❑ Hauler Tire Program ID i Site Suffix t`1 Facility Telephone E�i''uroZber Boo 7, ❑❑❑ ❑❑ ❑ ❑ _ .. .._ t�.; ^,Fr: " `, ¢,�,,1 Jt.I• y�s,� n,.$; 1 C-:3 THAT UNDER PEaA-'TY OG PP.7AR W OF THE � 1 �i 1.WS,- Y=STATE DF CA':;SAVL.THAT:RE _ �F�Iti 1�IF V 12�JiuE��rD j�tU:NSf'u L�f.•1�GT. '