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Fax Jun 10 2009 12:55pm P012/012 <br /> ———. r—Hut C17I f7 7 <br /> VVVKII UHUtM i NIANIrCO I <br /> 7 1274877- 25321 <br /> Wa trq lire Mauler 'IPllasto Tire eratqx <br /> McCoy Tn.1ck Tire Service Center, Inc. Namen nr� Pd <br /> 1407 Lone Palm Ave. Addrw: a r r <br /> Modesto, CA OS361 cit,. State: �) <br /> 209521-6221 J� Zip; 47 — 31 <br /> TPID-1274877-01 TPID with Suffix <br /> Load batt: a`'l "� Loud T e: Whole Cubic 'Yard []Ton Pound <br /> Decal # o a . Pick-up Count: — - ._ <br /> ucense #: T7 8tata: CR.1 laor Code: RWDY Defive Count- T w — <br /> SCZE MFG. DOT# TREAD _ WHEEL COMMENTS <br /> 2 GL <br /> 3 <br /> a —--- <br /> S <br /> 6 <br /> 7- <br /> 8 �. <br /> 10 <br /> 11 <br /> 12 <br /> r <br /> 13 <br /> 14 �. <br /> 5 <br /> 1 - — <br /> 19 <br /> 20 - <br /> Drivers Signature: P Date: ' cuatoer Si rWWre: parte:5 /3-c� <br /> m <br /> Drivers NamB (print cl ��►^C�; customer Name (print) <br /> 10"My ri°� Sir 0�!hky°I paQ.iry undo pro 1e ° a a`Aala a'CkIIbmIR IRt inlMrrroon I any undw pmrmly of pqury utaor!M d °Ula fit rUl0�h i �nl ma n annahon <br /> p,—d,A Orme I.ln�.•^'aw.wr.If'P+ddeti I am.were�,11i1�daiwoon al(rn s in!ommkn nwy P�°.�Oe0 AD�ve h le"aro Donaa r adultler,I am 2r �h ji 1 WnejjnU p ih�Y i,j�p La!m�a��ee <br /> rruuu avlpehaon,revoGBtifkl of f4inlel al IWWLd of to Wruu Tu.wWar R0041000 Prn�JaN mf'.-n a­[pN.gI"up 10 E25,W(i oar a5Y� RM�1410cs an aNtnlnhlralrvr p�r,elli°y up to Si fJC7p <br /> m�OhC r+Saource 09da vtll 142070 a.M trip reo+R ih-M P6110%W m 0166 Fur dwY.pe- P!i wolpbga Nr OFY*L+Oaxcbm rn PPEJK Rxsuute GD69 locG:n d200P <br /> 4lattiaor,w a0rtanbhaW F pa(lefoee lip n 118r04a par'r m"=pr day A+.erlred lq f vw <br /> � ) Imported Lotid G J Exported Load and Location Hauler Exemption.Status: <br /> �o�tl Address: [ � Gavarttirnnt <br /> v 1 ) LEA iwKernpt <br /> city.- state: l ]Agriallttll'al <br /> [ Common Carder <br /> vw_j (, -71 Qnn7)nlfan <br />