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WORK ORDER l MANIFEST <br /> 1274577 <br /> Waste Tire Hauler Waste Tire Generator <br /> McCoy Truck Tire Service Center, Inc Name: <br /> 1407 Lone Palm Ave. Address: <br /> Modesto, CA 95351 City: State: <br /> 208-521-6221 Zip: Phone: <br /> TPID-1274877-01 TPiD with Suffix: 1 - <br /> Load ©ate: I /.fit. I` Load Type: [ }Whole j J Cubic Yard [ J Ton [ J Pound <br /> Dual # ]Pick-up Count: <br /> Ljoense#: State: Coot Code: RWDY [ ]Delivery Count:_____ <br /> SIZE MFG. OOT# TREAD WHEEL COMMENTS <br /> 2 I t, <br /> 3 <br /> 4 t -- <br /> i <br /> 5 <br /> 6 - <br /> 7 <br /> 8 <br /> 0 <br /> 10 <br /> 11 <br /> 12 <br /> 13 <br /> 14 <br /> 1S <br /> �� 16 <br /> 17 <br /> 18 <br /> 1s <br /> 20 <br /> r. = <br /> Drivers Signature: ,Data: Cu_itufllef &,nature: date <br /> Drivers Name(printJ "` t Customer yams(print) , <br /> 1 canthi thid units E;m""V of perfurt OmL4&' +k.W or H+e S:Nir i,I(7dilrFnrn IIrtNIrkrnwatkn I WsHiy v'i��l-,:r peuMav um*Ta14'Ir6.c ul IN Btat�e at CAONi voat tnq"kMamom <br /> w"),10ya aCo4M:s(hull*ICILmmot Yt aadbui,I act aurin than raivylrret:on d th On mal IfPMd&7 n r e.5 1".m c!,;C"a 1.in eddobiI.I&"d"m rt*4,14f&W at�ttne Mwmatton mey <br /> rasu! iusparwwz.reramQan er dww of nheW91 df theWau51r rm!ItauK+ ttStYdn pY7UBra �gLtl Ciear <br /> MII aa4ea w.to 525.0V rw da.c�pr itiiNacfi ar admi tetras a W.15.uo m 56 DM <br /> to 124APtb1C fde"wo rc*o Fecoa%4.19W one may raaun n cat wwiat b 4000 X 6Iy. Ctr+�datien oet OeY ac 6Ru d In P,maC li..pknlnc�a Code e6CfM a�'�@&'G. <br /> Ps YYotafi�n d OdmN1h#4hYe penalltee ut•f1 M',M�:of r4W~oar dov eY L%W-:E Wt RAA <br /> FtRy(Iuft]a Cbtle 5o[L!lrl+:{It;2 <br /> T [ J Imported Load [ }Exported Load and Locition Hauler Exemption Status: <br /> Address: [ J Government <br /> [ ]LEA Exempt <br /> City State:. [ ]Agricultural <br /> [ ]Common Camer <br />