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Comprehensive Trip Log Number Load Information Facility Tire Program ID Site Suffix <br /> Q 3 2 3 4 3 0 7 -- NPick Up ❑ Delivery ��, ❑ ❑—� ❑ <br /> DATE © / / ®© Facility Telephone Number <br /> Hauler Tire Program ID / Site uffix <br /> W Whole Tire Count Weight In Lbs. <br /> ® 1 ~ L'I ❑ .ani-ielAddress C <br /> Volume Cubic Yds. Weight in Tons <br /> 0 6 iassla ld�, i y,State ar-°, ip TA <br /> fn <br /> c� c. OtS a Z C� y Q �;Label <br /> Hauler1 iel�laoruy Number ® [:] Address Same as Hauler Initials <br /> I CERTIFY THAT UNDER PENALTY OF PERJURY OF THE <br /> (N 1e for TireLAWS OF THE STATE OF CALIFORNIA THAT THE <br /> (j// WhOIC ) INFORMATION PROVIDED ABOVE IS TRUE AND CORRECT. <br /> V <br /> y <br /> TRACY-DELTA SOLID WASTE MGMT, INL�:'`; <br /> j <br /> Tracy Dlspbsal El Delta Disposal West Valley Disposal ❑ <br /> P.O. Box 274 <br /> Tracy, California 95378 <br /> Phone (209) 835-0601 <br /> Customer# Date <br /> Name IC `:L� 1 f' S ! f <br /> Address <br /> Driver `l S- PO# <br /> Dump/ <br /> Description Size Contents Delivery Amount <br /> Roll-Off Box ��D $ <br /> Compactor Receiver $ <br /> Overweight Ton @ $ /Ton $ <br /> Misc. $ <br /> Gross Wt <br /> Tare Wt Total Due $ <br /> INVOICE # 13212 Red By < _ <br />