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dept.of Resources RecyeOng and Reeovary <br /> la CA Cor>'.iprehensive Trip,Log-and Receipts i0002 Po� �� s.o » ,L� � <br /> annto•� ,2-' <br /> _-Com rehensive-Tri Number <br /> t CM � .Exa'MP L .E 1 2 .3 .455613.8 <br /> oto w`lNSTRUCTIONS ON BACK OF PART:2 DO NOT TAPE.-STAPLE OR DUPLICATE <br /> tN NpnMp t!W CAC•nOnf+anarn 1Np Lo•and RaodPt.Un etgnagl f Wa•.t pVl ew Yibmutlo+�Pvv4•e o,,dit tam u*be oan"nid OoaedwtW PMOfft -ane L.M.•a.L k1••sord•no•wfth rd .14 CCR so-UM <br /> -Iron sl owl.H•reamem Is mads fa d*down of Ods Wdorm•tle•.capAcyet•.6 oonuet the sW wwW of Oft Mm to tM.Atraaa.nd 1W phos•n�a°ba PrM6W on&"fanw or t.CMpl <br /> Vehicle rmation Hauler Address I <br /> Truck Decal Number , rr,A�,' PA. <br /> RECYCM <br /> � � 19114 K HWY99 <br /> ® ® ® ® ® City,StatOfV Zip ACAMPO.C 9M <br /> License Plata Number State <br /> 4 ���.Carrier n. <br /> ., F <br /> y wider penYy d pvkry alar tha twa of tM Sf.Ss o1 CaOMnYa test ttr Mbmwbn rawldw'Yi6a+wb4w.nd oomct rn.ddtian.t vn dat rblf of Nb 1. 61 aap.rrbn,r•Yocalion.adsi4l of nxisNd of <br /> aste Ti.HWtr Repiatrs0on pwswus m W61ic ..ctbn a29.0.nd m.y rmuR H ci 9.prutluu�p to S 23.000 pr dry,pr a W pr•rblatlon Or day aidsavmed inf�lLNc Raoww <br /> • aL Y V V J V! V I J a <br /> Driver's Name rant . !!!--_ v SiFacility Tire Program ID Siie Suffix <br /> ature Date - <br /> Comprehensive • •g Number Load Information <br /> a <br /> _....... �� Pick Up Delivery: '*=a <br /> 4551.38 D IO <br /> v Facility.Telephone Number, <br /> m m'ID.-/'Site Site Suffix' <br /> Hauler TI <br /> ra <br /> cc -- .. - DATE • 11 ;� D� F <br /> Baa <br /> E]Whole Tire Count 0 Weight In Lbs. <br /> a <br /> Facility Business <br /> r •. •. Volume CLAbic Yds: Weight In Torts' .!Maine/Addriss <br /> ^ Citi State and Zip <br /> Hauler Naito rT l .i :F r <br /> U / a ': mp or Label OK <br /> Hauler Tel one Number o'"Address Same as-HaUler-' <br /> (WAl- f caRrur yiw �ror as w wufxr ' <br /> I YfAoI•Tlrsa) uwsosy►EvwT7tnuraueiwo <br /> a.` • • ••• • • • Program <br /> r� 4 556138.-= B Pick Up. Delivery' D 0 013 <br /> �;. <br /> Facilfty.Telephone Number.• _ <br /> ■ Hauler Tire`Program ID ,, Sits 3uffac a .• Da ' <br /> at - - DATE. ., <br /> �- 00- Dun00 <br /> t ul.a <br /> Who Tire Count 0 Wetght m Lbs. <br /> Facility$usines's , <br /> 0 volume Cubic Yds.❑Weight in Tons Nai ne/Address <br /> RaRt =Cilli Ste:aixi Zip> !",....t. <br /> o Hauler-lame. _ �.: : r _,�:.� .;.�-` - '• <br /> ~Sthmp or.Label OKE <br /> Hat�lel hone tVutribe , y�-•_��^ - ■ D Pildress;Sarrie.as�iauler_. <br /> / A OVE uoaruA <br /> for i ceRr�i naA�uNocri PENALTY OF es+win of Tile <br /> LAWS of THE. 9F.Cµ <br /> INFORMATOa PROVIDED ABis TRUE 'C <br /> e <br /> tt y^ X-• <br /> ��•.A .Comprehensive Trip Log Number Load Information Facility Tire Program ID Site Suff ix <br /> Picklp 1 Delivery <br /> AS <br /> CX <br /> m r*Program ID / Slte Suffix. •DATE x Fftility Telephone Number <br /> y - r_j a 00' <br /> c; w 9Whole Tire Count p Weight 1,Lbs. <br /> m • ' a (Facility Business <br /> .�. Volume Cubic Yds.•❑Weight in Tons Name/Addresss� <br /> City,State and L• <br /> a auger Na e - '1 14li NMI o <br /> Stamp or labe� r� r r ' <br /> • t1� <br /> :`Hauler Telephone Number <br /> O , Address Same_as Hauler r a <br /> (WA for I,CER]7Y THAT LMDER PENALTY OF PERJURY of THE <br /> MOW Time) Lo%VM OF THE NATE W CAUFORfM THAT TW <br /> �/ <br /> INFORMATION PRVJIOf.D'Atl011E 18 TRUE AND COIiHEC'C. ' %l,•- <br />