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�.Comprehensive Trip <br /> Log Number Load Information Facility Tire Program <br /> 5686769 APick Up ❑ Delivery.21 <br /> CD <br /> a - <br /> 0Hauler Tire Program ID / Site Suffix -Facility Telephone Number <br /> � DATE <br /> co <br /> a Whole Tire Count Weight in Lbs. <br /> r I Tacility Business; <br /> 7 j 7 ~ ❑ Volume Cubic Yds. Weight in Tons Name/Addrgss: <br /> 0 Hauler Name city,State and Zig_ <br /> cj Q stamp or Label OK <br /> -Iau1 r Telephone Number DDOMN-HE 7 Address Same as Hauler tn;tlals - <br /> (Al- 4 <br /> jJ / / J (N/A for I CERTIFY THAT UNDER PENALTY OF PERJURY OF THE <br /> 1 /W/ a(J Whole Tires) LAWS OF THE STATE OF CALIFORNIA THAT THE <br /> INFORMATION PROVIDED ABOVE IS TRUE AND CORRECT. <br />