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Dept,of Rebourod6 Recycling and peoevely'
<br /> . CR Comprehensive Trip.Log and'.Receipts '10002 P.O.Hox12591bucremento,CA86912�1269
<br /> 1 r Com rehensive TripNumber
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<br /> 6tefe el OsBT
<br /> I r�re,dy�,2atpireJINSTRUCTIONS ON BACK OF PART 2 [3.0 NOT TAPE,STAPLE OR DUPLICATE �'
<br /> \. .By etpnlna this OACompr4hendve Trip Lop end Raoelpp j the elanette)request that the Informallan provided an Ihb form will be nonskid red aanildentrd,proprietary and trade edorel,In aaaordenca with Title,t4 CCR,Section.
<br /> 17041 et pq.pl(a request le mede'for dieoloeura o!fhla Information,OalfleoYola will contact Wo ei8nerte)of this form at the eddr4s►end letephano nWnbor provided on this form or reoalpl.
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<br /> Iha Vtnla Tire Hauler Ro0lolmllon puisuipl to Public Wourees Code icon.42660 end may result in civil ponelites up t0$26,ODD pa ag er Aoletlon of adrnlNsl Ines up to 11 per I Ion perdoy as desorlbmd In Publlo Raaourcos
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<br /> t;`,'�i r irJ/+tCr I CERTFpY THAT UNDER PENALTY OF PERJURY OF THE
<br /> y•r, a LAWS OFTHE STATE OF CALIFORNIA THAT THE
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<br /> t titular Yolojilione Number 'MI Address Sarno as Hauler gree s
<br /> ICERTIFYTHATUNDERPEHALTYOFPERJURYOFTHE i
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<br /> :Y.tl Ts• ;:•�'I':k;';-.`� ii"::X�!'-" Y�t�•rt.w INFORMATION PROVIDED ABOVE 19 TRUE AI7tl CORRECT.
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<br /> `T' ti'• °''�� i, FDEltYIFYTHAT JND`ER. Ef)ALTY;OF 1168JUBY.OPRNE
<br /> "•� ��r�`` ��t �J/'f ,�! -•a P 's''S' t ' " I.AVr6bFTHE STATE OF CAl'IFDR7tIATHATTHE
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