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Recycl <br /> ng <br /> Recov <br /> i0a CA Compr_ehensiv_e 'rip Log and Receipts C''. ofRevuurCe9 al"ta,Cand 12-1259 <br /> 1 000? P.O.Box 125tin,SacrarnrntU,CA 95917-1259 <br /> Comprehensive Tri Number <br /> calRecycle �I�A�� P LIC 1 2 31 - 4 <br /> rilquIde22.1v1 ONSTRUCTIONS ON BACK OF PART 2 DO NOT TAPE. STAPLE OR DUPLICATE <br /> By sill"lnq this CA Compreh.—trip Lu-,f Haca 1pt,11v sIq"r(*rogjo*t thr,t Ir:a:Jram:Ninn MoelAed on Ihb Icrm wIU bo Consldeled conl`detHul,pruhriilary and trado sacat. In arr"daneo with Tilta,14 CCR,Seotltn <br /> 17041 el flee.,If a requeel is made for deialo7uro or this 1ptereP kilo-,Cullus:)Cle will coatnct lh�flepr_rill al 11116 corm at the address and fele phone numlim pmriied on 11176 NMI ar rucsigit, <br /> Vehicle Information - <br /> Truck Decal Number <br /> � ,� �- ,�l f ltr�^'.v rtr <br /> L;tl ,[k1�3. 5_i��ill� it '�`� '% "'"� f1 <br /> 1 j r 1 cldrC9e"V - <br /> �! -rid Zip <br /> License Plate Stat <br /> Number e <br /> o a o Id a o 4rlll�tr}7 L r <br /> rtI�l <br /> I Ca.hiry under rcnafN a1 p4gi,ry lotd.,IM tTvs nl rhe SIA1e o1 Catr11 nia lhal ina InWinklWn r—ide:l el»sw is Issue eecl cnr I:r mKiloa,l em arvem fhal7a7s Lk,:illan of this iJoramfan n,"msul in-spension,rev--ion,or den7al of-.—Al ni <br /> the Waste We KI Vir au'striM to PLOia RUeGun:6,s Civ1e 8 W sC i 42:190 rir4 rosy<esull 61 ciol pisiallliu up Iv S 25 1JC0 per day,par y{0h111oodi pati¢pemllh:s up to Sb.0 J per violalimn per dsy es denrilmd In Pubte:ETeew— <br /> Codane_IWn4146P –�r'�� –✓1 ' <br /> if <br /> Driver's Name(print) Driver's Signature f Date <br /> Comprehensive Trip . . Number Load Information Facility Tire Programtr Site Suffix <br /> a <br /> 4596047-- C Pick Up Delivery <br /> Hauler Tire Program ID / Site Suffix l Facility Telephone Number <br /> N DATE <br /> .,r oa �( �- a �� aoaoo <br /> a Whole Tire Count Weight in Lbs. <br /> 0 Volume Cubic Yda. E] Weight in Tons <br /> _Hauler K'411ile <br /> HaWeir7tientigne AM,re- :m Rauler Lim.. <br /> t - i CF.RTIW THAT NNQ!R PENALTY OF PI-R"RY OF TML <br /> (NIA for ! <br /> Whole Tire s) LAWS OF THE STATE OF CALIFORNIA THAT THE <br /> 1 11f INFORNATION PROVIOM ABOVE 15 TRUE ANO CORRECT. <br />