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A 2 Pick Up Delivery 3748917 f] EHNONEH-HE = C=��] 4 � ' Hauler Tire Program ID Site Suffix r H HF,771 Facility Telephone Number DATE © aa �o� oo � oLo � � � Whole Tire Count [:]Weight inLbs. Volume Cubic Yds.OWeight in Tons E E /12 0 E741 0 0 A-i t--s Same 0. lauler I elepbone Nlw"1130' EEOP M 1= '-' - I CERTIFY THAT UNDER PENALTY OF PERJURY OF THE ❑ 2 (N/A for LAWS OF THE STATE 01 CALIFORNIA THAT THE 4) --01 1 Tires) INFORMATION PROVIDE ABOVE IS TRUE AND CORRECT. Whole EC, ❑ U. Comprehensive Trip Log Number Load Information Facility Tire Program ID Site SuffixL F79 .0 0 > a o ❑ a ❑ ❑ a o Pick Up Delivery ❑ 3405994 -- C 4) (D -L 11, Facility Telephone Number 4) Hauler Tire Program ID Site Suffix DATE F�l El ED to ❑ ❑ ❑-❑❑❑ ❑ a ❑ ❑ - EE ul Count Weight In Lbs. M 0 Whole Tire Facility Business L) rp, I r] Weight in Tons Name!Address "FS 49-� 2: rE] volume Cubic Yds.1:1 n EQ 4) City,State and Zip E 0 [Hauler Name /CI-7/z . CL EE- M -6 Stamp or Label OK 3: p U X� w Address Same as Hauler initials Hauler Telephone Number ■ I CERTIFY THAT UNDER PENALTY OF PERJURY OF THE r (N/A for a 3dA1 Whole TIres) INFORMATION OF nTOHE STATE OF CAUFORNIA THAT THE A M NFOR'AA N PROVIDED ABOVE IS TRUE AND CORRECT. X Comprehensive Trip Log Number Load Information Facility Tire Program ID Site Suffix Pick Up ❑ Deliverya a a M R-j- 3405953 R, P Comprel 34 0 Ti Facility Telephone Number 2 Hauler Tire Program ID Site Suffix 17- cc DATE �r-q E IIA CD 013 oa©-PRPDDoo 0 U) Whole Tire Count Weight in Lbs. cc IL 0 11 Facility Busincst� Q ;7 Weight in Tons I (-) �'\ E] volume Cubic Yds. E 0 M < Add,ess Same as Hau ier !�U-Jei hr-),nrr Nurnhf�, 000DEMIE I Is jd!a3a8 1'saijuevy jewolsno I CERTIFY THAT UNDER PENALTY OF PERJURY OF THE (N/A for LAWS OF THE STATE OF CALIFORNIA THAT THE 5/,2 Whole Tires) INFORMATION PROVIDED ABOVE IS TRUE AND CORRECT.