COMPLIANCE INFO - Laserfiche WebLink

Home Browse Search

Dept of Resources Recycling and Recovery CA Comprehensive Trip Log and Receipts 10002 P.O.Box T259,Sacramerft%CAg58T2-1259 (Wftp EXAMPLE 1 2 3 Comprehensive Tri Number f 'nNgINSTRUCTIONS ON BACK OF PART 2 DO.NOT TAPE.,STAPLE OR DUPLICATE ' 484807 Oy vD rhe CA ComprYiruM TttP Lay.rd Recelpl,die elyv.r(s)mW..t thrt the hdorrvetlmt;.*. a on the form will be consi kr•d confidm+tia4 pn*ci@WY aid trade secret In accoidr+e•wft TIS.,14 CCR seeder,. 1TWI rt.p.,IF a r.gwat a mid.for decfo—of flit.Irdarrradan,Ceivf cyan wM coated the.pw f.)of thM faem at d,.addmui ew tsMptw n nlbw P4ovtded—Oft farm or r—OL - Vehicle Information Truck Decal Number Hauler Address r Business Name B.rAxilno ^: City,rState and Tip License Plate Number State �� 1 e ® ® a e UE ,;KE Gammon I csnity under penally of per*xy under the laws of the State of California that the ation_p w ed e .n addition,I am aware that falsrriation of this Infomiadon may result in suspension,ro ocation,w denial of ren•wa1 of the Waste Tis!tauter Registmhon punuent to Public(1—umm Code sect rpuit in a it lliekp to S 25,000 per day,per violation w administrative penalties up to 55,000 per violation per day u described in Public Resources Code section 42992 /Driver's Name(printf. 7 Driver's Signature Date Comprehensive Trip Log Number Load Information Facility Tire Program ID Site Suffix .m 4848076 -- C D Pick Up Delivery �U 11d.U — d Facility Telephone Number Hauler Tire Program ID 1 Site Suffix DATE ©© , ��•;'ae y m IL,®,Whole Tire Count []Welght In Lbs. g Facility Business QI El Volume Cubic Yds. Weight in Tons Name/Address Hauler Name City,State and Zip 0 Stamp or Label OK a• l Hauler Telephone Number DEEn�oAddress Same as Hauler Initials • (N/A for 1 CERTIFY THAT UNDER PENALTY OF PERJURY OF THE _O Whole Tires) LAWS OF THE STATE OF CALIFORNIA THAT THE I' INFORMATION PROVIDED ABOVE IS TRUE AND CORRECT. V/ AlComprehensive Trip Log Number Load Information Facility Tire Program ID Site Suffix ` 4 8 4 8 7 6 -- B D Pick Up D Delivery , [10001100 - A Tire Program ID ! Site Suffix Facility Telephone Number Hauler N DATE U) _ c n Whole Tire Count Weight in LbL a s a a a Facility Business m «t. ❑Volume Cubic Yds. ❑Weight in Tons Name/Address o Hauler Name City,State and Zip v a Stamp or Labe!OK [7auler Telephone Number ■ Q Address Same as Hauler Initials (N/A for 1 CERTIFY THAT UNDER PENALTY OF PERJURY OF THE _ Whole Tires) LAWS OF THE STATE OF CALIFORNIA THAT THE _ PtFORMA710N PROVIDED ABOVE IS TRUE AND CORRECL Comprehensive Trip Log Number Load Information Facility Tire Program ID Site Suffix a4 8 4 8 0 7 6-,t.- A Pick.Up ° .. Delivery_ ©- , mFacility Telephone Number Hauler Tire Program It) / Site Suffix DATE OR / a© / Al --j _ - © ® LJ H y � •Q �wrote Tire count Q Weight in Lbs. ��t�ir -��`� ��h :�(S • z \1I LAI .E]Volume Cubic Yds. E]Weight in Tons I E Hauler Name v Qr.►�wv�lZ a HCot .q sZj Hauler Telephone.Number E.EOME- Address Same as Hauler r� (WA for 1 CEfrrWY THAT UNDER PENALTY OF PERJURY OF TME Q,` Whole Tres) LAWS OF THE STATE OF CALIFORNIA THAT THE v INFORMATION PROVIDED ABOVE Is TRITE AND CORRECT.