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(tie) <br /> y - WORK ORDER I MANIFEST <br /> — I .._._ _. <br /> 1274877- <br /> Waste Jiro Hauler Waite T*rrg Qenerator <br /> McCoy Truck Tire Service Center, Inc. dame; r ,✓ � �t e" <br /> 1407 Lone Palm Ave. Address: <br /> I� <br /> Modesto,CA 95351 City: State: <br /> 209-521-6221 Zip: Phona. <br /> TPID-1274877-01 TPID with Suffix! <br /> Load Date- Load Type: ( j Whoie ( j Cubic Yard [ j Ton ( j Pound <br /> Decal # — _ - - — — ,- [ ]Pick-up Count: <br /> License F State Dot Code: RWDY [ ]Delivery Count:— <br /> SIZE MFG. DOT#_ TREAD WHEEL COMMENTS <br /> 2 <br /> 3 <br /> 4 <br /> 5 — - <br /> 6 �. ' <br /> 7 � i - <br /> 8 <br /> 9 <br /> 10 <br /> � 11 <br /> 12 <br /> 14 _ <br /> 15 - <br /> 18 - <br /> 17 <br /> h -- <br /> 18 - <br /> 19 �.�.. <br /> 201 <br /> Drivers Signature: Date: Customer Signature: Date <br /> Drivers Name(print) ', Customer Name(print) <br /> I+xaiHy 41at undm Papally 4t perp*y w 8itd i 75 of[hot Stapp at Calr*rrva Q51'rF, <br /> 1 cw lry INd LMlar;w*Iy M wWr'f�*Y the:e..e cr Ire swb to cot f nmi low 014 g0a,iIhtev <br /> Ff0'tvlad elb4wa 111 NA/e hrd LArtar;1.to edd441 I am eWmfP that tairAcohaft hl fNy p�Cwtded atr I m 13 tue and cuffo 11t attdAunn,L atm{mate ifbl YilSln'�1rjfYl.pr IY+a 1,1bm r wn trdy <br /> iVt .t rx iafxrstan rari.,,atron,u defriaf 0 IN4.61 of IM Wpais TM I uw tran (11911;1 cMI oanar.,q up tG 525,035 Per doyy,tr.rw,*Won a p4mtmWwaLsm ponaleari up 49 J6,02 <br /> M 7111 Nld is f8eaonn�r Q:nSa a nsw 42%0 and mey raIR/M wn e5(ii�leaatapri WO ay Lc^wulannfl per daY esdacl'ped h•;P�titc.Ra11o1rG11[+we sccefx+i2:.tS? <br /> Ilaf�w'a�Sun lY plfnrahelkvr pr!nnhrer,tp M 5�,4 crit PS Mialehnn pof day ea dexiMd In F tc <br /> C+eawr�Cade c9(Atfa asyd2. <br /> Imported Load [ j Exported Load and Location Hauler Exemption Status: <br /> Address: ( j Government <br /> [ 1 LEA Exempt <br /> City Stale: ( ]Agricultural <br /> ( Common Carrier <br />