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- ,, <br /> 'YVORK PRDER I MANIFEST <br /> 1274877- <br /> Wa,5te Tire Haller Waste Tire Generator <br /> McCoy Truck Tire Service Center, Inc. Name: <br /> 1407 Lane Palm Ave. Address: <br /> Modesto,CA 95351 City: Sta:e.. <br /> 209-521-8221 Zip: phone: <br /> TPID-1274877-01 TPID with Suffix: <br /> Load Date: Load Type: [.J Whole [ ]Cubic Yard [ J Ton [ ]Pound <br /> Decal #_ - _ — ( ]Pick-up Count: <br /> License#: :P =:Ie Dot Code RWDY ]Delivery Count:------- <br /> SIZE 'MFG COT I; TREAD WHEEL COMMENTS <br /> 2 _21 !' f / <br /> 4 <br /> t3 "! <br /> 8 <br /> 10 <br /> 12 <br /> i3 <br /> 14 <br /> � 15 <br /> 16 <br /> i7 <br /> 18 <br /> 19 <br /> 20 <br /> Drivers Signature: _ Gate: Customer Signature: Date <br /> Drivers Name(print) � <br /> r,.,-*=r 11 1 Customer Name(priMA <br /> I cen/Y;int ixLdor Csr'rnitp of poesy -HW In**of"'M S."of CW4048 OYat the inhjrmeboo t cerbTy Ina vr.-* enaily d a+IGu^r urtiler;ne 4awc C1 vo filar ref Cay.� , <br /> rrar9'1o:1 ON"la Iron end mrroct Ni adder ar,i am■+caro thel fuer!mtlan d.this Iron^nY COv.dBd etave.s born and carro:z.M addition,i pin&Wes.W&I lalvc r n�� y� <br /> '"-J 'n warAnOlon roytnypry�.W dw%jl of-w*.d of tho 1Vn41s The H&,z&PAM pXstMlq mul:M';�,r-a%vs rip In SVI.WQ w pny,per rn5t rr xdrt nelrnin a r'alto, <br /> in 119 FLVk Rave ce Ccda secri0r a. and nu r rr.n DY0 oanoW0o up 10 047 day poi valOLgn peg day a,d*$0.t+ed in R-I!ik Rosanr.b rata oochv 4296_2 <br /> Q='. <br /> or odnnalrBtrrhve p_K-K�p h:SL Wo W vnIMM.poi dly NO;*$0 ed In IwM <br /> +Ssoorrco Gnae seG7tn 429E2 <br /> Imported Lead [ ]Exported Lead and Location Hauler Exemption Status: <br /> Address: [ J Government <br /> L <br /> [ ]LEA Exempt <br /> City State: ( ]Agricultural <br /> ( ]Common Carrier <br />