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May, 10, 2013 11 : 55AM jjj�m EXPRESS STOCKTON No. 6676 P. 5/6 <br /> .., _ 2e. „��A MCCOY TRUCK '_ --- 04/05 <br /> U <br /> WORK ORDER/MANIFEST <br /> 1274877- .4 6 6 7 9 <br /> Wa>sto Tlrs Hs filer <br /> McCoy Truck Tire Service Center, Inc. Name- E otv,5 �1407 Lone Palm Ave. Addrose; -76 t 4a2lI0(L ' ' <br /> �\ <br /> Modesto,CA 93351 City: 9tetr. <br /> 209-521-6221 Zip: 4 5��-t r Phone: T,*4L) <br /> TPID•1274877-01 TPID with Mix: <br /> Load Data: Load Typo: Dq Whole [ Cublo Yard ]Ton Pound <br /> Decal ## - It ]pick-up Count: <br /> LicenseState: Dot code: RWDY Dellvery Count:_ <br /> SIZE M DOT IM _ TREAD __WHEEL COMMENTS <br /> — - -- — --- <br /> 10 <br /> 12 <br /> 13 <br /> 14 <br /> 15 <br /> 16 <br /> 17 <br /> 20 <br /> Drivers Signature: Dete: Customer Signature: Data- <br /> Drivers Name prin -5;-Zol 11111,2hA,4ij, Customer Name(print) <br /> I e.r r x�encyr ofper��.r.rvm IMI I or ll� I.d Leon I una.r wn�M va una. rr urw o v,e Esar.a a�oarna a,.�e,e Inrormamn <br /> provt eeovo m nand aorrdtc In adauvn,t■M AYeI may nava m ouo efd wne�c M uddpw,l eln ew ev tml rmdectlo.l a Inm nkrr cem r w <br /> maji In—Punaim,M4GAllav,a donlel of 1-1 1* Weanbiro" Re0.hcntlan prism ,eeuL"P—w mla;M,OW Car 0�y pervbbtlon a�aOrBbr{re1l�pr wto LG.RA7 <br /> Iv Cls DwM10 f qRe�Cede eedlan Is p AV rtay rmuRln eNl pnnallee up Iv f2G.aaape�day. vm v464 per deY ms daaalpaC In rVEflO RMa�o Wh�rlfpn <br /> iID M�ocom M+p ghk4 up la 6,000 par wl&zm xr da m wow win RAA. <br /> CaAe 2 [ ] Imported Load [ )Exported Load and Location Hauler Examption Status- <br /> Address: [ ]Govsmmant <br /> [ ]LEA Exempt <br /> City State; [ ]Agricultural <br /> Common Carrier <br /> Received Time May, 10, 2013 12 : 01PM No. 0632 <br />