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t TRACY-DELTA DI PO _.L SERVICE CO. <br /> ! P.0 Box 274 <br /> i TRACY, C LIFORNIA 95378 <br /> r <br /> Phone ( 09) 835-0601 <br /> ll\VOICE <br /> Customers - <br /> Order No. ate `. L5 <br /> Name \ -- �' `v i, !` i�� V Lam✓ <br /> Address JI1' 2 0 2M0 <br /> ENVIRON <br /> c)�iI I[ATI-I <br /> FER^Yi!(;'S'E".VICES . <br /> DES RIPTION <br /> + 1 rs <br /> ROLL-OFF BOX - <br /> COMPACTOR RECEIVER <br /> MISC. <br /> i <br /> KEEP THIS SLIP FOR REFERENCE <br /> 25206'1 Rec'd By <br /> Facility Tire Program ID Site Suffix <br /> Comprehensive Trip Log Number Load Information <br /> i <br /> Q 3 2 315 9 4 -- <br /> yp <br /> ick Up Delivery H [3] EHHE-Ed <br /> n Facility Telephone Number <br /> Hauler Tire Program ID / Site Suffix M� <br /> DATE <br /> LLLLJJJJ � ��ooa <br /> a ® <br /> w [:]Whole Tire Count Weight in Lbs. <br /> M a ility Business C_kv �•.sy t e? S`rte <br /> F' PV lume Cubic Yds. Weight in Tons :��nE(Atidress � _ <br /> Say, State sand Zip Nrl <br /> Ft�rn�orLabelOKi ! A.elcIress Sa6-se&s hauler Initials <br /> i"ial eir f PIC�pho 'a i'lumbeDUD[ EMRE I CERTIFY THAT UNDER PENALTY OF PERJURY OF THE <br /> /ti <br /> IN/A for LAWS OF THE STATE OF CALIFORNIA THAT THE <br /> Vry <br /> \J 1�A1v) r WhDle Tires) INFORM11ATION PROVIDED ADOVE IS TRUE AND CORRECT. <br />