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Fax; Jun 10 2008 12;54pm P005/012 <br /> "fes✓ � � rrv�i . ....i..J.��.. � � ,�., ti.... <br /> a <br /> 1274877— 22,986 <br /> Waste 'Tire Hauler Waste Tire Generator <br /> McCoy Truck Tire Servica Center, lnc. Name. �'V PAN n.S c5p`1 <br /> 1407 Lore Pairn Ave. j,\°I Address: �, wy `z� ���'4 <br /> Modesto.CA 95351 city: S - tr-' State: ' <br /> 209-521-hZzi ZIP- !�'z 1" pr Phone" �p I q�, ! 3 �j-3 <br /> [�TPID-1274877-01 TPID with SuTTIX f,4 3 1'� 113 ~ a <br /> Load Date_ I Load 7 e; Whole ]Cubic Yard f Tan Pound <br /> Decal # [` Pick-up Count: — <br /> License #,n.z eri Dot Code: RWDY ) Delivery Count: <br /> SIZE MFG. OOT # TREAD WHEEL COMMENTS <br /> 2 <br /> 3 <br /> 4 <br /> 5 <br /> 7 <br /> 8 <br /> 9 <br /> 10 <br /> 12 <br /> 13 <br /> 14 <br /> 15 <br /> i6 <br /> 18 <br /> 19 <br /> 20 <br /> Drivers Signature^ Date �) Customer Sipa ` Dais: Z -t!f>� <br /> Drivers Name ( nt �'� �A4- Customer Nape (print)�=r�3� �. ► <br /> I c.rU4 T �f10ef 07)&V el Pa fy ver IPM lwv�a 11 I's or CAIlloln N Iho Aomenam r wntty IRHI'RI r panalN al Dauoaor dte'dn 1web 51aw of OrCf_'K it IA M1Wffaai0^ <br /> prwaad nowa 4 -e"a k U 601tbn,I P;�--m RIM 4 TIficabb-of Ih-,rIt"n41100 MW Pray K cr oaavo Lt toil and Wvth In.0M.P,I am aware Inc f*PjD.rl.n of ft 6*Mwicn mq <br /> fb+vlt T Nle w'1Non,rovxollan,o danral W rmauat al lM'�ial.Tra Hpyir RtrWw�bn parsrl�U rd ul m avil DDINInda IN M M.000 f+*spy,par wkl.I�a w.r.Nnlrinr..+p.iYlbel W 10'�6.POG <br /> Io P4blk Mamurce Cade reall0n+ZGe0 iM rtliy f sw h aM pw,dG.a up to d�7S,000 0.r air par Dar IDISOn prr Imy M aawwald m Pubku Alw as Code w1lon 42102 <br /> �rOlallan or adrllrb rpliva pmrdtl.s Lv Id wAoO ief-MR1100 Awrdofcr'"In PWV. <br /> AWLM1V "oI"t'U <br /> [ ] Imparted Load j 1 Exported Load and Location Hauler Exemption Statua^ <br /> o�c p��l� Address: ( ] Government <br /> ]LEA Exempt <br /> City: State: I I Agdculturai <br /> [ ]Common Carrier <br />