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tn <br /> FORWARD SITE TICKETGRID INCORPORATED <br /> _ h C1 :i 4333;; <br /> 9979 South Austin Road/WEIGHING LOCATION P.O. Box 6336 •WEIGHMASTER <br /> Manteca, CA 95336 Stockton,CA 95206 '.^ 'm.*]r 7 <br /> La fiII: (209) 982-4298 WEIGHING LOCATION Main Office: (209) 466-4482 DATE IN "': - ::TIME IN <br /> Rf urce Recovery: (209) 982-4936 Fax:(209) 465-0631 . A-PT i _L 7 0 fl 4 9 . r,� ai <br /> 004355 --'DATE OUT I ::TIME OUT^ <br /> @` A x F33GT_R(1t°TiviENTAL 7 Ar>.-i'_ 2004 10 27. a=:1 <br /> LIZ HENRYVEHICLE ''ROLL OFF <br /> 331fl SWETZER ROAD <br /> LOOMI3 Ca 995650 REFERENCE ORIGIN <br /> -Ontract-, 4355# Lo )I <br /> 00 Cross Weight 40,080.00 LB arhound _ SCALE TICKET <br /> Tare Weight 16 ,480.00 LB <br /> _ Npt Weiqbt 23 ,600. 00 LB 11 . 30 TN <br /> `-'OTV. UN4T^rv't „ r.',';+:3"y� i� ct ..;, ESCRIPT[QN, {' s`,dd<,$ �+� ""•K's+? r.w RATE - ^EXTENSION TAX- - -TOTAL <br /> 11 , 80 TPI U CLAS' I.T. COVES: SOIL <br /> u <br /> WI HMASTER CERTIFICATE THIS IS TO CERTIFY That the following described commodity was weighed,measured,or counted by a weighmaster,whose signature Is <br /> on is cerMticate,who Is o recognized authority of accuracy,as prescribed by Chapter 7(commencing wtth Section 12700)of Division 5 of the California Business <br /> and Professions Code,administered by the Division of Measurement Standards of the CalHomla Department of Food and Agriculture. <br /> - NETAMOU,NT <br /> .:TENDERED"- <br /> MANIFEST #285308 <br /> .ry.CHANGE'` <br /> d <br /> n• /J� <br /> DRIVER'S SIGNATURE /�r�''�'-•�71-'t�'� <br />