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00oww4whenol"Tsip Log Number Losid Information 146"tw Tim Program 10 Site Suffix <br /> —A - - 1'r;.k !11> �f U��fiu��ry 1J L4 U? 1 a — U ❑ <br /> s ` i , Facility Telephone Number <br /> ;Ifo ()ATF <br /> 111 iI1 l I I II( I I / II /��! <br /> uI �� Wlu,li• 1 ur•r;r,IN,T � � Wr•III'h1 n+I t,. <br /> u �^D <br /> Y �,` \ � w T �. '. � I f Vnlnnu• C;ub+r.Yrl•: ( I WeuflTf In Tnn•, ., <br /> IN/A Ir,i 1 GFRTIF'I'T'HAt IINDEP PENAlt`/hF PER JI;P.v OF�a5: <br /> LAWS OF H <br /> THE STATE OF CALIFORWA' AT THE <br /> ttIFORMATI ON PROVIDED ABOVE IS TR�IE AND:ORRE CT <br /> Trip Log Number Load Information Facift Ti m ID Site Suffix <br /> re Progra <br /> I <br /> 0 1 J 9 -- A Pick Up Delivery E E ❑ ❑ h- -❑ ❑ <br /> a I,,ieF The Proyr.im ID i Site Suffix Facility Telephone Number <br /> - ,- DATE ❑ ,`> �❑( �I� I_ <br /> w Whole Tire Count Weight in Lbs. <br /> ❑ ❑ FL�3 ❑❑ ❑ o <br /> Volume Cubic Yds. Weight in Tons rL� ` 1-4 <br /> a <br /> i (N/A for I CERTIFY THAT UNDER PENALTY OF PERJURY OF T.E <br /> Ll C r �; Whole Tlres) LAWS of THE STATE OF CALIPORMA.THAT-,H- <br /> 4 INFORATION PROVIDED ABOVE;S TRUE AND CORRECT <br /> Comprehensive Trip <br /> Number Load Information Facility Tire Program 10 site suffix <br /> Log <br /> L. <br /> 7' ' <br /> r v <br /> 1 '� __ Pick Up Delivery 7 ^' r <br /> ❑ ❑ ❑ <br /> Hauler Tire Program ID I Site Suffix DATE r Facility Telephone Number <br /> 1. ❑ <br /> Lu Whole Tire Count Weight in Lbs. <br /> Volume Cubic Yds. WeiWirTons <br /> CG� P �UULJ"U <br /> �- a <br /> (WA for� tN;IB1S <br /> , o/f I CERTIFY THAT UNDER PENALTY PERJURY THE <br /> `f[ <br /> LJ I tJfs ( f{ I� <br /> Whole Tires) LAWS OF THE STATE OF CALIFORNIAI THAT THEE <br /> INFORMATION PROVIDED ABOVE IS TRUE AND CORRECT <br />