Laserfiche WebLink
Comprehensive Trip Log <br /> a 4596031 se- B Number Pick Up Delivery ©R-3-2-0-— -©-©-- —_- <br /> Hauler Tire Program ID / Site Suffix DATE TU, ®® 0 <br /> ® 0© Facility Telephone Number <br /> 2 7r <br /> AH R 60M <br /> gum, <br /> C w yr'Whole Tire Count []Weight in Lbs. <br /> to ,g <br /> 101/ r E]Volume Cubic Yds.E]Weight in TC <br /> T..o � \ � <br /> E <br /> /GG/ L vomer <br /> MEEAo �t c�r� . <br /> -/ OF WS THE SATE OF CAUFO ERJUIrFOF <br /> X.Tire.) LA <br /> ( RIFORNAIM PROVIOW A■WE Is TRUE ANO CORRECT. <br /> e V■■ ■ ■vV ■ VVV–VVv vvVV/ as VV vtr V4a•e VV•V■V.Vra., v IF A see W1171 - <br /> Dept.Of Resources Recycling and Rocovery <br /> CA Comprehensive.Trip Log and Receipts X0002 P.D.sox 1259,Sacramento,CA 95019-1259 <br /> Comprehensive Trip Number <br /> CalReCyCle E I X 1596019 <br /> te*'d',c "(Will ON BACK OF PART 2 DO NOT TAPE STAPLE OR•DUPLICATE <br /> he s19nK(al reggnt that the inram■tbn provided en this tam will bi considered Confidential,ProPrwM'and Indo secret.In sccord■nce with Tills,11 CCR,9iotlon <br /> 9Y alp"Ing this CA Compnh■mM.THP Leg■.r Realpi, _ <br /> 17041 at.eq.,If.ngO..t h mads for disclosure of W Inlormoil",C.IR_Y t.wal con/sat CAR.gtw+Nl et Ihle term et the Address and lelephana numMr Provided en W■form or reaelpt. <br /> hicle Intormation l <br /> i'rauier i-�(itil"i3 <br /> Truck Decal Number �llStt9P., i�i8.11iG <br /> a - - FI) a a , <<3 �L�y(Staa� JI _C;ic�r,Scats and Zi(, • <br /> License Plate Number State ~~ rt L <br /> y a Gy U a uD 4.,, , L� -,�'•l,�it �,.4. 1:� :J...,•(tr•� �.f <br /> 0 � conTL,ta�, �_� -_, <br /> Carrier <br /> t a1 of <br /> nyy undo pensay of p■W undw the laws of tM Stan of CNhofnta Chet the 4iorrrutbn From"e0aw 4 Yue end tonsCL M eddalon,l nn Rware 0rlhlstfleeti■n at 1py Was up 1.may pa tion�ay as decor.bareddki wial �Re�suRc■s <br /> IN Weata T re Hauler Reyl■tntun pursuant to Pubaa Rae—c.s Code focWn 42909-W m■Y reeuhin d l penehle■up Io$25.000 per d■q,per vyl■0o,�xr tlNalJsMre V}na as up to 15'000 p!r '_J <br /> Code secOon 42902 <br /> Driver's Name[r.lint) D'rlver-ts !Date <br /> Comprehensive Trip Log Number Load In • • .. t Site Suffixi <br /> Delive LE01- 1,0004596018-- C Y, Pick.Up rY I— <br /> Facility,Telephone.Number <br /> Hauler Tire Program ID / Site Suffix E]q <br /> 9 DATE .r []M <br /> LID <br /> Jaaaoaa � a <br /> w Who[.Tit.Count ❑We[ght in Lbs. <br /> r <br /> J( Volume Cubic Yds. Weight In Tons <br /> 3 <br /> U t \ _. i,;' i; ■ V'/ �IAddressSame gas( -001' initials <br /> (N/A for ICERTIFY THAT UNOERPENALTY OfPERJURY OFTHE f•, <br /> iV - Whole Tlra■) LAWS OF THE STATE OF CALIFORNIATHAT THE'. 7� <br /> `V �x -INFORMATION PROVIOEO ABOVE If TRUE AND CORRECT <br />