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<br /> Dept,ofResouraae Reoyo" entl ITeoMe
<br /> CA Comprehensive Trip Log.and Receipts 10002 i P.O.Box12S0,8D6Tament6,CA05812-1260
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<br /> c r�Traatalrr�ro�INSTRUCTIONS ON SACK OF PART 2 DONOT TAPI=,STAPLE OR D.UPLiCATE ^r.> �, .� '.•> _ <. .
<br /> By III;hi9.1410
<br /> CA Comprehensive THP Loa and R000lpl,the ellInot(e)requoll Ut•t the laformsllon provided on age form will be moldered confidential,propHotery and t ode sscret.In s000rdeno•w,th THla,lq-oOR,Bedllo, '±
<br /> ( 17011 et seq.,If A request 1.mode for dlsoloauro of till.Iniormnlion,DalReoyals will contact Iti•elpner(e)of Ihleform at the addreeued telephone number.pmvidod on this form or ryeslpt. ,
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<br /> i oWfy underhenNy of peduy undlif the lays of the State of CQUornie that I ie Information provided above Is true and correct.in addition,)am 1001:41Wall Ietsgkolion of thla lnforfnoflon rpry welt in suspenslon,revocation,or derail*11(lined of
<br /> the waste The Hauler Repishtllon pursuant to public Ruoumai Cod*section 12060 and may result M civil pensiliss up to S 26,000 per day,per vaoiat(on oradminGr+pllve p*9al0aa;tup to$5,600 per violation per day is deiwlbed an Pub6o,Resomw
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