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4 <br /> FORWARD ° SITE TICKET GRID <br /> INCORPORATED 01 144157 D-98 <br /> WEIGHMASTER <br /> I AUStIn Road/WE(GHING LOCATION' P O Box 6336 L. MARt�IUE <br /> k 9 9533b f Stockton,CA 95206 <br /> 9)982-4298 WEIGHING LOCATION Main Office (209)466-4482 DATE IN TIME IN <br /> urce Recovery (209)982-4936 Fax (209)465-0631 08/111 /99 12187 <br /> 866540 DATE OUT TIME OUT <br /> SEMCO 08/11 /99 13:51 <br /> MaRK DREWRY VEHICLE ROLL OFF <br /> Y�17•-POUTH 7th STREET RHT 990 <br /> MODESTO CA 95351 REFERENCE I ORIGIN <br /> 866,200 NELSON READY MIX <br /> Scale 1 Gross Weight 70700 L8 Inbound -- Charge ticket <br /> Manual Tare Weight 33140 LS <br /> Net Weight 37560 LS <br /> QTY UNIT DESCRIPTION RATE EXTENSION TAX TOTAL <br /> 18,78 TONS Class II Soil by Ton <br /> ,HMASTER CERARCATE THIS IS TO CERTIFY That the following described commodity was weighed measured or counted by a welghmaster whose signature is <br /> )is certificate who is a recognized authority of accuracy as prescribed by Chapter 7(commencing with Section 12700)of Division 5 of the California Business <br /> Professions Code administered by the Division of Measurement Standards of the California Department of Food and Agriculture <br /> NET AMOUNT <br /> MANIFEST # 108704 <br /> • TRUCK # 9C31389 <br /> P.D. # NONE PROVIDED TENDERED <br /> TRAILER d# YC5460 <br /> Schedule 24 hours in advance directly with �he landfill . CHANGE <br /> Call (E09)98e -4293 to schedule. <br /> Drive Safely t ! CHECK NO <br /> recycled paper I <br /> 4`• DRIVER'S SIGNATURE <br /> 4 � <br /> J <br /> J I <br /> - ENv1RQN��R 10ESLCH <br /> • p�RM <br />