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i WORK ORDER i MANIFEST <br /> 1274877- a i;5r, <br /> Waste Tire Hauler_ Wasite Tir Generator <br /> McCoy Truck Tire Service Center.Inc Name: ? <br /> 1407 Lone Palm Ave. Address: <br /> Modesto,CA 95351 City: State: <br /> 209-52.1-6221 Zip: Phone: <br /> TPID-1274877-01 TPID with Suffix: <br /> Loan Date: lh /rt- Load Type: i i Whole [ ]Cubic Yard i )Ton i J Pound <br /> Decal # r' �I: - ," ��I " [ ]Pick-up Count: <br /> — — <br /> License#: ''r�_, "fstate: .4_ Dot Coda: RWDY [ ]Delivery Count:— <br /> SIZE MFG. , DOT# TREAD WHEEL COMMENTS — <br /> �' - <br /> a <br /> a // ---. --- <br /> - --- r <br /> a <br /> IL <br /> 10 <br /> 12 <br /> 15 _-.... <br /> 16 - <br /> 17 <br /> �0 <br /> Drivers Signature: Date_ Customer Signature. Date:,', : !' <br /> Drivers Name(print) , Customer Name(print) <br /> r�_ry f!,ri iar3n�;�.,i:ccy�.d 0aryuh uWef M•aeera <br /> of the Sime of cah'ar that err i nn I tMr tSr that✓.Mar pena+3A'01 Pe N7 under tt"La d the Staid tA CaXA M tho Ih14AXMPar <br /> ,u.+rmi atx>.d l'rim➢n2.arr-1 In addNgn.!em wwttr+i iMl tiMad,�y:tyr at�".q I - tun nw! ,row Jed abmw IY kue W'd gin'9e1.In r4rSw.rt.1 am mumu inae WRACAdw es ihrf i*.o I tuan May <br /> -r,tdl r�aa+t�an► ,rgvtYrAlltM q cNn1711_W rM+PWd d iha'h'ach Sre!tadtdtx(1a:,tleb ar putauaht r"kA OW Wnail"W tr;Now' <br /> Ptt>•Jr)�ver Ada�l7n r1f edmirvBViQM14>serwba8 yr to$S:.a'ki <br /> m 1tw PWxa:Huswrca Curie zenttd�29U0 grid rvvy raNP m(�A t9enit0a4�p t9 M 000 w dao. cer wobtgn Gey dfI ee�1e9[+'thbd rti P4,ac Pj� a,-C+oaa aaCikm 43992. <br /> frTin vMdrUl Sf adlTd'eaVeifNa r+''M u0 td 111 7 Pa+o mlal an Mr day eS dMUdrid M F/ttr, <br /> Rst:c,ro Godo wttltan 4:2991 <br /> tmpo ted Load ( J Exported Lead and Location Hauler Exemption Status: <br /> Address: [ ]Government <br /> [ j LEA Exempt <br /> City State: [ ]Agricultural <br /> [ <br /> ]Common Carrier <br />