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FORWARDx s <br /> .� <br /> 7. a '. TE � : TICKET ,_ .. GRID <br /> 51 <br /> `+I INCORPORATED a _ <br /> 9999 South Aust4{ Road/WEIGHING LocnnoN P.O. Box 6336 ,::I- <br /> WEMIJMASTER <br /> Manteca, CA 95336 Stockton, CA 95206 ' <br /> Lz hill: (209)982-4298/WEIGHING LOCATION Main Office: (209) 466.4482 DATE IN TIME IN <br /> Rr �Iurce Recovery: (209) 982-4936 Fax:(209) 465-0631 <br /> { - DATE OUT TIMEOUT <br /> :VEHICLE .ROLLOFF <br /> _ .., <br /> L!iOM a.!j'i .� C'., y�_ -.,,.., <br /> is 'REFERENCE ORIGIN <br /> f <br /> '. _,:h C,Li,(?d - _L .. . . <br /> t.f:-'�-{• <br /> W i-:) nY L.I�J n�F�ii;l i,l 1 <br /> QTY UNIT. , ".DESCRIPTfONT••. `'^`�{`I"� ' 4" ';6` RATE' " --'.EXTENSION, '..TAX' TOTAL. <br /> j <br /> .. ." L <br /> {r <br /> W [HMASTER CERTIFICATE THIS IS TO CERTIFY That the following described commodity was weighed,measured,or counted by a welghmaster,whose signature is <br /> on this certificate,who Is a recognized authority of accuracy,as prescribed by Chapter 7(commencing with Section 12700)of DMslon 5 of the California Business <br /> and Professions Code,administered by the Division Df Measurement Standards of the California Department of Food and Agriculture. <br /> c - <=NET AMOUNT" <br /> f <br /> S <br /> a ,.� 'w• ':�y%,,�- _ -. .. - TENDERED'. <br /> CHANGE <br /> ,� ' •` 'CHECK NO. <br /> DRIVER'S SIGNATURE <br /> s-- <br /> f <br />