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CE111omfa Integrated Waste Mam,,.nt Boerd <br /> CA Comprehensive Trip Log and Receipts . "10002 P.C.BOX 1259,Saemr-to,CA 95012.1259 <br /> E!x A M P L E i 2 3 Comprehensive TriNumber <br /> owvg"ra,(ioasl INSTRUCTIONS ON BACK OF PART 2 DO NOT TAPE.STAPLE OR DUPLICATE 3 4 4 0 2 5 9 <br /> 87 Manlrq tw-CA CP.npnn•n•!v rnP RPa•ne R•u1PA nr Mpnr(q am•d•n0 cenRWn1W,PrapWry•ns'Inae••u•L m.uorauw•.Im ntM,tt CCR.8--ft. . <br /> .. 1]011 n••R,N•npugt 1.m•e•Ia al•cimas rr NV InlPnw•tla,,On CIWMB will cwnM Y Ow 4en•H.)01 tltl•ramal UN,•eG •rd WI.PNar women P—ioad m a w tam a—ipt <br /> e cle n ormat on Hauler Address FF ,. <br /> Truck Decal Number Business Name ` ��� 12�5 <br /> Address sHoW�L'5oa K", < <br /> v <br /> 1 City,State and Zip <br /> License Plate Number State .SYo(,� aJ R <br /> Common <br /> arrier. <br /> I wr6IY urdar INa1ao d PMIurT'uMn Iro In.e al R 2 CelitonYe tMl Dw IntormaORn PrPN6e0 sew•I•Yu•W rurart In e0ellbn,l am swan Sul Abelutlon of 0IN bRbnmtl•n 7ryll <br /> nNww•I a eIrh Tb•IlaR•e4 W wPutlk Cosa•Wen 12960 entl—Yra.un InWM Pe-e uP 10375.000 Pn eq:qr wwlwon,tMn..a P W .Cl• 12062 tea.. _930703.0 �;Name rint). Driver's SignatureComprehensive Trip Log Number Load <br /> Information ... g Site Suffix <br /> g3:4402-j9 -,_C— Pick Up, 4C: ,_..Delivery <br /> Hauler Tire Program,ID._/_ Site.Suffix Facility Telephone Number <br /> R HIP H H(SHE <br /> w D Whole Tire Count Welght In Lbs. <br /> f a 4b1 rl`�.6iIiiy Business V 0�C ; '0 -�t�-r . <br /> atlVoiue Cubic Yds.[]Weight In Tons Name/Address-' '1 <br /> E m <br /> o Haulerrl City,State and Zip��� ►J GUd 3y. <br /> Name { r t, <br /> No <br /> E H 'Stamp ortabel OKtHauler,Telephone Number . ;0 Address Same,is Hau e' <br /> vin lH,. <br /> Gyy (N IA for i' I CERTIFY THAT NDER PENALTY OF PERJURY OF THE,' <br /> • '`,y tl 1 A{!'ly%. Whole Tlne owe of THE STATE OF CAUFORNIA THAT THE (/ <br /> ) INFORMATION PROVIDED ABOVE IS TRUE AND CORRER. - <br /> Comprehensive •• Number • • InformationProgramE Site Suffix <br /> 34402,59 t-= B., Pick Up Delivery �-a D.-NMEN <br /> _� ¢� � <br /> f Y', .. "`. a Facility Telephone Number- <br /> Hauler Tire Program"ID' /,Site Suffix tY P <br /> t; 47,- DATE <br /> ( Baa-©�oflao <br /> Whole Tire Count E]Welght In Lbs. <br /> f FacilityBusiness lZ-G 'Ck-MIN O timi j <br /> `w I O 5 52_t ❑ Volume Cublc Yds.;[]Weight In Tons Name/Address. <br /> tatean _ <br /> o Hauler Name "` City,S d.Zip 2ti � �^1 H �• <br /> Stamp or Label OK ! ,/��• 1 <br /> aooa <br /> Hauler Telephone Number ■ Q'Address Samelas Hauler <br /> "�w`) rl y t� (N/A for I C�IfT FY;TNAT UNDER PENALTY OF VENJURYHE <br /> ,OF T ' <br /> l Whole lime) .LAWS OF THE STATE OF CAUFORNU�THAT THE" <br /> MMMAR N PROVIOEO ABOVE t9 TRUE AND CORRECT. `r <br /> orn <br /> d Comprehensive • • • • a a a Programa <br /> 3A T-]Pick Up Delivery <br /> Huer <br /> Tire Site Suffix ID Program / Facility Telephone Number <br /> g DATE <br /> []Whole The Count []Welght In Lbs. <br /> aoo-aa0000 <br /> a Facility Business <br /> ❑Volume Cubic Yds.[]Weight in Tons Name/Address <br /> o Hauler Name City,State and Zip <br /> a 10001 as Stamp or Label OK <br /> Hauler Telephone Number ■ Address Same as Hauler <br /> (N/A for I CEAnFY THAT UNDER PENALTY OF PESLRIRY OF THE <br /> Whole Time) LAWS OF]TIE STATF OF CALIFORNIA TNAT THE <br /> =,oA OEO ABOVE RS TRUE AMD CORRECT. <br /> I <br />