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1: _ WORK ORDER I MANIFEST <br /> 1274877- 5 110, <br /> Wasta fire Hauler Waste Tire QgnDjator <br /> McCoy Truck The Service Center, Inc. Name: ,IV f� � <br /> 1447 Lone Palm Ave. Address: <br /> Modesto,CA 95351 City: State: <br /> 209-521-8221 Zip; Phone: <br /> r <br /> TP[D-1274877-01 TPID with Suffix: / <br /> Load Date %', ; Load Type: [ )-Whole [ ]Cubic Yard [ J Ton [ J Pound <br /> Decal # _ <br /> ��l 1- r [ ]Pick-up Count: <br /> License#:3 :,;Ed State `4 . Dot Code: RWDY [ ]Delivery Count: <br /> SIZE MFG,_ DOT# TREAD — WHEEL. COMMENTS <br /> -- Tell- <br /> k/ <br /> 10 <br /> 12 <br /> 1 13 — -- -- <br /> 14 <br /> 15 <br /> /t3 <br /> 17 <br /> 18 <br /> 19 <br /> 20r <br /> Drivers Signature: Dat Customer Signature; _ Date: <br /> Drivers Name(print) '" .r .w ear. .. Customer Name(print) l- F <br /> I C,efldy dial Jmr—ra9811y or pans y wlU7Nti twN la"M I Inn of :pl�M1;xl,*t Yhet:m II n+a7keri Ira C•ul ly,dNx=111=111y, <br /> Nnw �of .._ o <br /> outlnd H4t;ve le Irve r �r FwluFy I1=U*i!Va+la d the,dnt bl ta6wo. mal llvl IMcrne�m <br /> Ix aryq 70n4Y!In NdddW1,141wi NMrylla IIW1 INlndq�,ito a 1me Mf Iraq ptlhWbd et»Rn rx Mag Ulvy tYirraCl In addlnCn 1 NI"1 Nanro 7TIN1 lAkR4aH1/6rt� I�i I -,;,t, n•+"�:•, <br /> re%lt'wl Y19y r;oo1 ryvoLam,,or dalbo a imowCI Cd ft y4,o"TMJ1 14l411ar 17N aLNn pwlyuwl T9Li1 chi(aMtlf001 Up'n$,,25,000 Ileo yyNY"Oer»dwnen pf adTHd Rlr*ltm rx r '.1 <br /> IG 7w PWic.R-w-ve CC 11r 4NCIIwn 42$0 Xod mfav r#trj"In cr rl penadas I.Ip Na j25,,Nq�+a dqY, .,w wie"Pwr day as dn*z;11b a in%U c gnaawca Code aedm 47W <br /> Ilex va7wa w"ai"'n4 Wa pe"a two nn w VW r-yrlamn pqr do-0 w nwsnibad m vtIl4 <br /> a.1 Me NN A—47"2 <br /> vDate [ ] Imported Load [ ]Exported Load and Location Hauler Exemption Status-, <br /> Address: [ j Govemment <br /> 'Tr [ J LEA Exempt <br /> qP city State ( j Agricultural <br /> [ ]Common Carr"er <br />