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m <br /> N <br /> �v O <br /> N <br /> W <br /> Sit <br /> N <br /> •Comprehensive Trip • Load / I) V/ <br /> �. <br /> oQ -- o � a � as Cn <br /> 4380074 8 0 0 7 4 -- CPick Up Delivery © © � �. — 1. I o <br /> o <br /> tir Hauler Tire Program ID / SiteSuffix DATE f Facility Telephone NumberCz <br /> �a a© <br /> W [ Whole Tire Count L1 Weight In Lbs. <br /> / <br /> o l r Volume Cubic Yds. Weight in Tons ., <br /> ct'C r c`�sE Eiz.�d► <br /> _a.- �c ,;•::; �.._..I "1;'3dr ns Same,i•`5; I'e�a.l�ni' <br /> 1N/A for I CERTIFYTI UT UNDER PENALTY Of PERJURY OF THE I' <br /> Whole Tlrey) LAWS of THE STATE CALIFORNIA THAT THE II <br /> �•r^ CCC C /// ( INFORMATION PROVIDEE D ABOVE IS TRUE AN GOR RECY. <br /> Light Truck Tires $ $ F License# <br /> Truck Tires $ $ <br /> Misc. Tires $ <br /> Wheels $ $ Payment Information <br /> 1 <br /> Trailer Placeme $ Cash $ <br /> _ „ N <br /> Trailer Switch Check $ I <br /> I <br /> li w <br /> Trailer Removal $ Charge $ <br /> 1 <br /> T 0alDue ��` Total Received $ I W <br /> z O <br /> Driver Customer <br /> Signature: t — Signature: <br /> f, <br />