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Toll Fvee 1-866-896-0600 / www.calrecycle.,ca.goiy/Tires/ <br /> CA <br /> A / —t, �R' ` ! Receipts <br /> Ocpt.of Ragatireas Raeyollnp and Raeovory <br /> Pa CA Ct�niprehensive rip [wog and Receipts 10002 P..O.Box1269,5aommento,CA95812-1259 <br /> Comprehensive Tri Number <br /> CalRl�cycie ?�._Al P_� 1 z . <br /> �rq aamu�aa`"�rrty INSTRUCTIONS ON BACK OF PART 2 00 NQT TAPE. STAPLER DUPLICATE= <br /> By algninq this CA C—pmhanaivo Trlp Log and floaciol,the algnerfol request[hal.the iLfarmallvn pravldad an this Isom wm be cpnsldered confdenGal,praprietaryand trade aeumt In....risnes with Ties,14 CM.HasCpn - <br /> 17.41 et lett.,p a ieauest Is—da Far Asolasvro at this Cnlermation,Calpo-aycle vall oaron.t the alonvr(s)of this form at Lha address and lelophane nu.nber provided m this term of teWpl. <br /> Vehicle Information <br /> Truck Decal Number i3tfl: r (kdlr}r�� <br /> �l 31(sinew MrIV-) <br /> �J "ity.Stare Zr� -rip � z� <br /> Liconso Plate Plumber State ,•� �"; `, "4'C% <br /> I rultu f 5indet P--IL/d pVJi 11-y an(taf Iho LIN*of Me Stale al Ua Lea1Na 11-y Ihn 1,11-311rm provided above to true wad correct.In adddfur•Ion awam that fafsll(W lion M Ihtr Inlotmmum tray Ieault in suwsrahLL fev&W l0n,or cAnist of rvnawsl of <br /> the M. fe11ry Hwlarl{vt2lctrallen ryimu:nl to V.01.14a5cuLcan Coda ocher 42960 aid may resulf In eiut pardtian Lip tot 25,000 par cloy,parvoWlen orarl 4.1Falivo penohies up Io SSJMA Ott tidatlon 01r clay as ddeLMOed In p-Mle.RrsQJws <br /> Driver's Flame(print) ��-&rgiver's Signature :%Uafe <br /> s • .• . . • • <br /> 1 4 5 9 6 0 61 -- A Pick Up Delivery I L L -L] <br /> _ <br /> I, Hauler Tire Program ID / Site Suffix DATE �a Facility Telephone Number' <br /> �L a �� o � 0000 .� aa <br /> e' n. L] Whole Tire Count Weight in Lbs. <br /> m � <br /> (•;r �' 7 l ~ VUlume Cubic Yds. Weight In Tons <br /> o HaulerNffainc <br /> t i <br /> 1 .l(fc.l Yeft� taartc Nfimber EDE U-0E E-] A,•: .aI QC...a fZa(,113,- lnfifato <br /> ,.,(WA for ICCi4 FY THAT 41040CR EKALTY OPPERJINtY OF THE �-711) <br />