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WORK ORDER J MANIFEST <br /> 1_7 <br /> 127= 877— ', a <br /> Waste Tire Hauler Waste Tire G _n -rator <br /> McCoy Truck Tire Service Center,Inc. Name: <br /> 1407 Lone Palm Ave. Address: <br /> Modesto,CA 95351 City: State: <br /> 209-521-6221 ZIP: Phone: <br /> TPID-1274877-0,t TPiD with Suffix: <br /> Load Date Load Type: [ J Whole [ J Cubic Yard ( J Ton [ J Pound <br /> Decal # _ - _ [ ]Pick-up Count: <br /> License# 7�; state: �` .; Dot Cade: RWDY [ ]Delivery Count <br /> -SIZE MFG DOT;; TREAD WHEEL COMMENTS T <br /> 34 <br /> s - [ <br /> 10 <br /> 11 <br /> 12 <br /> 13 <br /> 14 <br /> 15 <br /> 16 <br /> 18 <br /> 19 <br /> 20 <br /> Drivers Signature: —•, t]ate: Customer Signature: Date. <br /> Drivers Name(print) '° Customer Name(print) <br /> rg!dfY lF.�l undor;yuahp C*.'utr y' i 14Me flt l4C }ipp iarr,`MVr nn nAom�elicm i co vy;,01 antler�oUA y 0 pw+p✓Y un4�Rw WI M]be-Slelc 01"Arc r.a "'val n. hh"'Wa l <br /> m <br /> p'L'+u1M IIJUre.7 7ua axl.40 Ih omn .l Mrt whom thin PN71(La"n of 1c nwdvn way t n.�ae7 aw v it 11L*&M mm".Yi add.ho,,,I e trw ,&inar wsiGtyikw of uNs n1ur'"WM mrV <br /> iMaull in suspamon,rw-vv wn,a d woof mMA.al of ars WqY!rib Y{yular eqw+nul�vinl _Ur oyl p'diu f up IC$25.0W pe.�iay.pef�+ataaurOr WmrvEtrm). pm�arersi ap LU S�.Ctl1 <br /> fP I"PUbk 90*ft ca�tr WOOS AM&pd ma raLun Ln r#xl panalteeo�!p ro 2�S.LNw oer day. 9nr-ft6m c«usr as deeatej�Fuaic Reearrcr;Ods"nisi 4z452. <br /> CeR'+NIsWn 4s oClminlabiMBvn peneMraa W,tp 5 7C+;:rvr„Nxon Pe+l'yr,as smaaa P�:vir <br /> H4aPurca-ifR1tr <br /> so, "n A2qu <br /> Vtc Data T, [ ]Imported Load [ J Exported Lcad and Location Hauler Exemption Status.! <br /> Address: <br /> [ ]Government <br /> [ J LEA Exempt <br /> City State: j j Agricultural <br /> i ]Commcn Carrier <br />