Form CalRecycle204 "Unregistered Hauler and Comprehensive Trip Log Substitution Form" - California

What Is Form CalRecycle204?

This is a legal form that was released by the California Department of Resources Recycling and Recovery - a government authority operating within California. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on April 1, 2010;
  • The latest edition provided by the California Department of Resources Recycling and Recovery;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form CalRecycle204 by clicking the link below or browse more documents and templates provided by the California Department of Resources Recycling and Recovery.

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Download Form CalRecycle204 "Unregistered Hauler and Comprehensive Trip Log Substitution Form" - California

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State of California
Department of Resources Recycling and Recovery
CalRecycle 204 (Rev. 04/10)
(CalRecycle)
Unregistered Hauler & Comprehensive Trip Log Substitution Form
-
Name and Address of Facility:
TPID#
Date & Name
License Plate &
Hauler’s Name/Address/Signature
Quantity &
Pick up/Delivery
Unregistered Tire
Decal Number
Type of Tires
Status
Hauler or Exemption
(if applicable)
Status
(if applicable)
Quantity of
Check One:
Unregistered Tire hauler
or
___________________
_
_______________________________________________
Tires:
____________
(License Plate)
(Hauler Name)
Exemption (if applicable):
________________________________________________
/
/
______
Type of Load:
Pick up
LEA Exempt
(Address)
Whole
Government
(State)
________________________________________________
Cubic Yards
Commercial Carrier
(City)
(State)
(Zip Code)
_______________
Delivery
Pounds
Agricultural
____
- _____________
Tons
_________________________
Or
Name of Reporting Party
Decal number
Signature:
No Manifest/CTL form
(if applicable)
Quantity of
Check One:
Unregistered Tire hauler
or
___________________
________________________________________________
Tires:
_ ___________
(License Plate)
(Hauler Name)
Exemption (if applicable):
________________________________________________
/
/
______
Type of Load:
Pick up
LEA Exempt
(Address)
Whole
Government
(State)
_____________________________________ ___________
Cubic Yards
Commercial Carrier
(City)
(State)
(Zip Code)
_______________
Delivery
Pounds
Agricultural
____ _____________
-
Tons
_________________________
Or
Name of Reporting Party
Decal number
Signature:
No Manifest/CTL form
(if applicable)
Quantity of
Check One:
Unregistered Tire hauler
or
___________________
________________________________________________
Tires: ____________
(License Plate)
(Hauler Name)
Exemption (if applicable):
________________________________________________
/
/
______
Pick up
Type of Load:
LEA Exempt
(Address)
Whole
Government
(State)
_____________________________________ ___________
Cubic Yards
Commercial Carrier
Delivery
(City)
(State)
(Zip Code)
_______________
Pounds
Agricultural
____
- _____________
Tons
_________________________
Or
Name of Reporting Party
Decal number
Signature:
No Manifest/CTL form
(if applicable)
Quantity of
Check One:
Unregistered Tire hauler
___________________
________________________________________________
Tires:
____________
or
(License Plate)
(Hauler Name)
Exemption (if applicable):
________________________________________________
/
/
______
Pick up
Type of Load:
LEA Exempt
(Address)
Whole
Government
(State)
_____________________________________ ___________
Cubic Yards
Commercial Carrier
Delivery
(City)
(State)
(Zip Code)
_______________
Pounds
Agricultural
____
- ____________
Tons
_________________________
Or
Name of Reporting Party
Decal number
Signature:
No Manifest/CTL form
(if applicable)
Please submit this form within 30 days to: CalRecycle, Waste Tire Hauler Program, P.O. Box 4025, Sacramento, CA 95812
Clear
Print
State of California
Department of Resources Recycling and Recovery
CalRecycle 204 (Rev. 04/10)
(CalRecycle)
Unregistered Hauler & Comprehensive Trip Log Substitution Form
-
Name and Address of Facility:
TPID#
Date & Name
License Plate &
Hauler’s Name/Address/Signature
Quantity &
Pick up/Delivery
Unregistered Tire
Decal Number
Type of Tires
Status
Hauler or Exemption
(if applicable)
Status
(if applicable)
Quantity of
Check One:
Unregistered Tire hauler
or
___________________
_
_______________________________________________
Tires:
____________
(License Plate)
(Hauler Name)
Exemption (if applicable):
________________________________________________
/
/
______
Type of Load:
Pick up
LEA Exempt
(Address)
Whole
Government
(State)
________________________________________________
Cubic Yards
Commercial Carrier
(City)
(State)
(Zip Code)
_______________
Delivery
Pounds
Agricultural
____
- _____________
Tons
_________________________
Or
Name of Reporting Party
Decal number
Signature:
No Manifest/CTL form
(if applicable)
Quantity of
Check One:
Unregistered Tire hauler
or
___________________
________________________________________________
Tires:
_ ___________
(License Plate)
(Hauler Name)
Exemption (if applicable):
________________________________________________
/
/
______
Type of Load:
Pick up
LEA Exempt
(Address)
Whole
Government
(State)
_____________________________________ ___________
Cubic Yards
Commercial Carrier
(City)
(State)
(Zip Code)
_______________
Delivery
Pounds
Agricultural
____ _____________
-
Tons
_________________________
Or
Name of Reporting Party
Decal number
Signature:
No Manifest/CTL form
(if applicable)
Quantity of
Check One:
Unregistered Tire hauler
or
___________________
________________________________________________
Tires: ____________
(License Plate)
(Hauler Name)
Exemption (if applicable):
________________________________________________
/
/
______
Pick up
Type of Load:
LEA Exempt
(Address)
Whole
Government
(State)
_____________________________________ ___________
Cubic Yards
Commercial Carrier
Delivery
(City)
(State)
(Zip Code)
_______________
Pounds
Agricultural
____
- _____________
Tons
_________________________
Or
Name of Reporting Party
Decal number
Signature:
No Manifest/CTL form
(if applicable)
Quantity of
Check One:
Unregistered Tire hauler
___________________
________________________________________________
Tires:
____________
or
(License Plate)
(Hauler Name)
Exemption (if applicable):
________________________________________________
/
/
______
Pick up
Type of Load:
LEA Exempt
(Address)
Whole
Government
(State)
_____________________________________ ___________
Cubic Yards
Commercial Carrier
Delivery
(City)
(State)
(Zip Code)
_______________
Pounds
Agricultural
____
- ____________
Tons
_________________________
Or
Name of Reporting Party
Decal number
Signature:
No Manifest/CTL form
(if applicable)
Please submit this form within 30 days to: CalRecycle, Waste Tire Hauler Program, P.O. Box 4025, Sacramento, CA 95812