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JTillard En.uir©nnzental. &rv-ires TAG NO. <br /> o* PO Box 579 19545 <br /> �` Byron, CA 94514 <br /> Telephone No. (925) 634-6850 <br /> Facsii :le allo, (925) 634-0569 <br /> Date �� JOE NUMBERS(8) JOC'�?IiMBFR3(S) tOB riUM3ERS(S3 3076 NUMBERS(5) <br /> TRUCKTRAILER,r� j — # <br /> j ERE <br /> HAULER <br /> PRIMEfEFt <br /> ARRI "i CONSIGNEE <br /> GAftrtl <br /> GENERATOR(S) Z.A DESTINATION ,S. <br /> CITY <br /> CITY REGI NGtI �J ENDI G MI <br /> FUEL-GALLONS FUEL-VENDO <br /> IVIATERIALS n COAD €3Ntf3ADiNG <br /> #'t #2 #1 #2 <br /> MANIFEST 1 YARDS OR TIME: TIME TIME» ,, TIME <br /> NO. wE.iG.HT ARR€VE - L£AVE ARRIVE,.. LEAVEr.e:. I . <br /> 2 <br /> a OFFICE USE ONL <br /> 4 TNSlFtRSlLDSf 5 / <br /> . . t <br /> $ <br /> TRANSPORTATION UNITS' <br /> TRANSPORTATION RATE; <br /> i <br /> p I SUBTOTAL-- $ <br /> g _.� p,fie.. i DISPOSAL UNITS: —w.r° ✓ T` _ <br /> 10t �J i1QJ [DISPOSAL RATE: <br /> 11 <br /> 1 "4" SUBT(TAL: S <br /> 19 BRIDGE-TOLL: <br /> COMMENTS; MATE RIALS: <br /> ST ST0 CsEOl1CT NE � � <br /> DFJIVVR <br /> RECEIVED IDA .. _6 APPROVED BY TOTAL CHARGES: $ <br /> TERMS and CONDITIONS <br /> - Paymaniternts are net thirty(36)days su6jectta a charge o/1.5%per month an ail Pass duo balances.to theev.rent the account becomes delinquent and Ills necessary to institute <br /> legal praceedjngJ i,CUSTOMER agrees to Pay DES:attamey's fees incurred in such prcoeeding,action or suit or in any ap at thereon.The parties agree that actions or <br /> proceedings arising in connection With this agreement shall be tried and litigated exclusively In!ho courts located In Contra Costa County,Ca!€fornia. <br />