Laserfiche WebLink
- - Ca111om1a I t gratEa_wDste Management BDard, <br /> CA Comprehensive Trip Log and Receipts 10062 P.O.Box 1259,Sacramento,CA 95812-1259; <br /> IEIXIAIMIPILIEI 1112131Com r hensive Trip Number",- <br /> c'nw„e"03(la"INSTRUCTIONS ON BACK OF PART 2 DO NOT TAPE,STAPLE OR DUPLICATE 3620136 <br /> ` <br /> By.lgning ft. <br /> CA C—pr .ma Tdp L" R-1,1.the slener(.)npu..l dut th.Nd—Ow Wllldttd m W.farm W11 M mnald.r.d cmlldmUal,pnpfM ,y 1r hvC —L ln.mardenp wlm TN.,%4 CCR,S.Wm Ii <br /> 17WI. q..n.ngtteat I.cud.for dMclo.un of lhl.IMottnatlon,Bt•C1 S W n mnt.ot th..,g (.)M Ods form.l lh.Wdr end ubph—nu pwld.d on Uds la—w n Ipt <br /> ehlelelint0rMbUdn Hauler Address <br /> a <br /> Truck Decal Number Business Name Les Schwab Warehouse Centers a — O E � ® Address 646.1V171x kladras Highway <br /> City,State and Zip Prineville, OR.M54 <br /> License Plate Number State <br /> D 11 <br /> .0 a H M" 0 H ❑ Carr ern <br /> �. .. <br /> I mMy—penally of pequry undm the laws of the Slab W Caffomla WI Ift Inf—alion pw de0 e0w -.w.erM mrteU.I .dd :I wan tbi FaNMcalim M NI.ry/'�'rpmeaon m. e.a n t u .im,ovomlbn. r mm of renewal a 1M <br /> Wmla Tin Hauler ReOlsaat pu—,to Pu011t Re .—,Code ceNm 02950 and m y Wt m tiv0 puruld..up Io s 25 000 per day, vbl.Om or edminatretiva parol4e.�m Wolau pr gay.aest�tlxd In Pua c R-- <br /> Code 02W2 - - . <br /> DriTver's Name(print) Driver's Signature ate . - <br /> Comprehensive Trip •. Number Load Information Facility Tire Program <br /> 3620136 -- C Pick <br /> Up,!, Delivery; — <br /> ❑ ❑ ® aa© ❑ <br /> Hauler Tlib Pro4rar i ID' /'Site'Suffix ` Facility Telephone Number <br /> . DATE / PEI <br /> RR / FIE <br /> m ii Whole Tire Count Welghfln Lbs. ©❑®-a a <br /> 2 Facility Business-Las SL1.�so ;rte <br /> m 1. O O 2 6 2 O 1 E]-Volume'Cubic Yds.El Weight In Tons. Name/Address 1 $O ✓1 4 I�.e 1r/L <br /> E Hauler Name City,State'and Zip �Scq Ina!c IN `tS3Zo <br /> ti <br /> Les ilrCt1W ibaUEDon(o .❑❑ Stamp or Label OKssame as HauAddreSlerHauler Telephone Number . ■ ❑ mrna)s <br /> 1- 41 -447-4I38 (N/A(tOI LA"ICE. Fr TNAT TATER CAUFO of PERJURY of THE r� <br /> N LAWS OF THE STATE OF CALIFORNIA THAT THE <br /> . WROb llres) IMFORWIIONrpOVN1EB_h. <br /> Vi le 4RuE ANT CORRECT. <br /> Comprehensive •• Number Load Information - Program ID Site Suffix <br /> a :3.6.2 0'13 6 -- B Pick UpDelivery <br /> 1111 -a a <br /> ❑a ❑❑ _ <br /> Id H P H U <br /> i m Facility Telephone Hauler Tire Program ID 1. Site Suffix DATE hone Number <br /> m a Whole The Count a Welght In Lbs: ❑ ❑�.Fa �I L� <br /> cility Business Ma��.d4 L—A <br /> m <br /> 1.10-10 12 16-4.12,;1 10..l ❑ Volume Cubic YdsWeight In Tons Name/Address 7S37L S 1. <br /> E Hauler-Name -- . - Clfy State and Lp' r/� <br /> %. rAr.�� art C xi <br /> i Les Schwab Stam or Label OK <br /> a <br /> ct <br /> Hauler.TL ■ 0 Q ❑=Address Same as;Hauler <br /> 1 C 7 ,• ,{ _ CERTIFY T Y UNDER PENALTY OF PERJURY OF TNE'_ _ <br /> 541' g 47- 4136 whOIB Tl 1w1. -LAWS OF THE STATE OF'CALITORNM TMT THE <br /> INFORWTTON PROVIDED ABOVE IS TRUE AND-CORRECT. <br /> Comprehensive • Log Number Load • • Program ID Site Suffix <br /> - <br /> 36.20136 A W Pick Up ❑ Delivery. ❑J ❑ ❑—� <br /> ID Hauler Tire Program ID / Site Suffix Facility Telephone Number <br /> DATE D�.� ❑� � as _EOHHH00 <br /> ---777"""'''""" 0 ❑® <br /> Ley w hole Tire Count []Weight in Lbs. <br /> o ft Facility Business4l�3,-,/ate G.'rc5&,(144/y <br /> m 110101216 � O 1 �' ❑Volume Cubi Yds.❑ �/ p <br /> Weight in Tons Name/Address c5 LDNAe- let VA <br /> E Hauler Name ° Nj t +$1 I w City,State and Zipg Sr,/a,j 'A SSZo <br /> v Les Schwab e Ano <br /> Stamp or Label OK 6Hauler Telephone Number ❑ Address Same as Hauler ,nTtlar•. <br /> 1-541-447-4136 (N 1A for I CERTIFY THAT UNDER PENALTY OF PERJURY OF THE <br /> Whole-n' ) I <br /> LAWS OF THE STATE OF CAUFORNW THAT THE <br /> INFORMATION PROVIDED ABOVE TS TRUE AND CORRECT. <br />