Laserfiche WebLink
ObIl Free 1-866-896-0600 / vvvvvv.c;at-eevc;le.c.a.gov/-I'it-es/­ <br /> Dept. <br /> Comprehensive <br /> of Rowureoa necycrrng and Recovery <br /> 2 �_AA Comprehensive Trip Log and Receipts 10002 P.O.Box 1259,Sacramento,CA95e12-1259 <br /> �a��ecycee C A M P I_ E 1 2 Comprehensive Tri Numb®r <br /> -u+ yz,r"o%tin INSTRUCTIONS ON BACK OF PART 2 DO NOT TAPE.STAPLE OR DUPLICATE <br /> By slpnitg this GA Combrehensive Yrlp Log and Receipt.Met sher orfs)inquest that the Inlc r"w an Iearlded on this lorm will he coneldarvd eardelaneal,proprfatary and Ir echo sorwot.In accordance with Tllle,14 CCR,Seellm <br /> 17041•t seq.,If a request Ie m•de for dlaclosw r of this•Ironnanien,CalRacycle will conleect Ire aignerrs)of thts form as the addreea and telephone nutnUor provided on title form or rr:oelpt <br /> Vehicle Inforrvlalion hauler Address _ <br /> Trunk Decal <br /> Number <br /> v.ir/ <br /> Business lklafi-ie <br /> A�dreSsaan , UP 0 )�State $ lc „ J <br /> I i:r�se 'ate Number State common <br /> r <br /> � <br /> I cw0j undes penalty at par"y meter the Faris of She State o1 Catrfanna 5n1 the Iriarmatlm provided above,;true and canoe!,In eddltfon,I an aware that Ielellloellon or Ms Inlornreeon mel result In suvenslon,irmeatlon,or dw*d of renewal at <br /> the Waste We Hauler RegiaRatbn purvani to PuAc Rein.wcos Godo seGlon 42350 avid msy m;uri In CW panatl,es up-W 5 25,000 par dey,per vnWllatpc'�1t�t;t�a7lre pdtallka up 1035i]W per tiaEetlon per day as described In Public Resources <br /> Code sonnei 42932 <br /> Driver's Name rim "--bri is Signature ` Date <br /> Comprehensive Trip Log Number Load Information Facility Tire Program <br /> Q ••- B a Pick Up Delivery a e <br /> al - <br /> Oj Hauler Tire Program ID Site Suffix <br /> / 1 Facility Telephone Number <br /> N DATE 11 E 1111 11IM � <br /> 0000000 <br /> a D Whole Tire Ccunl Weight in Lhs, f f <br /> Volurne Cubic Yds. Weight in Tons lr�r 'ta �# <br /> Q 1'Ic�t1I%k ii.::1C1C- '1 rh <br /> in <br /> Q <br /> Hauler Telop sono Number <br /> i.t.c.Sc�r..:,:��s7?n�� I i�rr1�1 OWN <br /> N/A tok IUNDER PERJURY <br /> Who le TirosHf. <br /> ) I.AWS OF SfAEiOF CnLR1JIA THA14 <br /> t EyTNE <br /> fNr-ORNATIONMOVOEDPBOVEISMrANO CORR= �.l f <br />