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WORK ORDER I MANIFEST <br /> 1274-877- 1 1 <br /> Mate Tire HaUlar Wasle Tire ft2gragr <br /> McCoy Truck Tire Service Center. Inc. Name: <br /> 1407 Lone Palm Ave Address <br /> Modesto,CA 95351 clty; State- <br /> 209-521-6221 Z-P- Phone,, <br /> TP 10-1274877-01 TPID with Suffix, <br /> Load Date: Load Type: f I-whole Cub;c Yard Ton Pound <br /> Decal # ]Pick-up Count: <br /> License State,, Dot Code: RWDY ]Delivery Count:— <br /> ';IZE rV F G DOI # TREAD vrdrFEt.L COMMENTS <br /> 2 <br /> 3 <br /> 4 <br /> 5 <br /> 7 <br /> B <br /> 11 <br /> 17 <br /> 19 <br /> 20, <br /> Drivers Signature: Customer Signature- Date, <br /> Drivers Name(print) Customer Name(print} <br /> Icomar 3wit.aft p4nmity srt*iwy wi(hwih.wm%m mia sista Wcioornia mm iro nf6itimilifn 1'6ff *" <br /> tY INA' 0 P"IV&PMVfY W " ,If UW SWft#(GWA ih <br /> OOMthat InWrj'- <br /> 'r-lielicied fir"is ITIM and WaINd.VI 4011"i•I am swwa VW WIRr"torih&Out;rwim-nahm may pwvtlad 200%r*Is tutu ern!— in awaa,n(am"Wa dw of th a Inkxratim rnap <br /> '9�In 101"OP11"50".F"oeaowl IF tiff 0!lwwr"40 Irm'Nesta Tim itauw F� to 62S.WO P"day,Pa vbwm v 841watnth-P�ham ap Yin$5 WQ <br /> In CC4&"r "110", <br /> ALI.4AI60 MC <br /> my MM& :M�Wjjini PLYNI'MIA "likin Wro Panda"Lin <br /> Lp CIN VC14fto PW day @a devohad M Pubk Rtic..'Wft Cotk sadiar.4.-W, <br /> Pair vKzwm or alp"Vol'ot"owialtsm WP to$5 W'1 F> 'ialmr —day a,d— <br /> Seo42%2 <br /> WImported I-mid Exported Loin and Loc.ation Hauler Exemption Status: <br /> Arag08 <br /> iNk— Address ]Government <br /> J�W LEA Exempt <br /> City State: Agricultural <br /> Common Carrier <br />