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09/30/2015 13:19 209521 MCCOY TRUCK TIF PAGE 03/03 <br /> WORK ORDER!MANIFEST <br /> W# bILI T"o <br /> 1274877-5 G k 9 3 OA <br /> r' W ste Tire Gena for <br /> Waste Tire Hauler <br /> McCoy Truck Tire Service Center, Inc_ Name: PS V <br /> 1407 Lone Palm Ave. Addre3.>td �fG�r <br /> Modesto,CA 9531 Cit i4y <br /> S 208-521-6221 zip. � Phone~j: y �� <br /> TPID-1274877-01 TPldwithSuffix: Q� <br /> Load Date: — - Load Type: hole [ [Cubic Yard [ ]Tan [ ]Pound <br /> Decal # -Q 2 `` ick-ui P Count: <br /> License#- _ tate: Dot Code: RWDY <br /> EGUtAR TIME [ ] OVERTIME [ ]CAU.OUT CUSTOMER POO <br /> FIAT REPAIRS EEL SWITCHES MT/DISMTI__-____— ( c�- `�" �'70 <br /> ry <br /> LICENSE NV. HICLE MA E r�911L, GE VEHICLE NO. <br /> LOCATION: )% <br /> WORK PERFORMED: - - -- _ MILEAGE IN <br /> AG <br /> TOTAL <br /> kY +�1c7_UUV1� 1 --- - 111E IN <br /> TIME OUT U O <br /> SIZE MFG. DOT 0 TREAD WHEEL COMMENTS <br /> . . A_. ..moi. 0 <br /> 2 <br /> 3 <br /> 4 <br /> 5 _ <br /> all <br /> 6 <br /> e �9ar>;<�- <br /> Drivers Signatu r Slgnaturw. f--`' <br /> Drivers Name print r µ� Customer Name(print <br /> per!tlut u�aar pw y or pslun urdo�tho laws ar Slab of 17a4efNa Ihal M►Monne I mwy fiat wda l ib oe�lua vRMf Qq k"M m m.w u caManw r"Po initr,noaan <br /> y{yad abo+b ti!an0 rnr�.n Mmlon I am aam M tldMrdm of 11v� bre Mey p oAnaa aBaw b Mua ab�racl In addMdt I am aware 41a1 U6Pbavn M rnti tMamraon mv� <br /> ieaak In eu.pnndon.�vwmem.ar e.rYu crronewel a ay wliM 71n atlAr RndMlaaon P+awnt' iesu!dull D�nlea UC b f'25 OOP ryr per. r duMbn or LID ID l5,OOD <br /> too*PuW Rgsyxm Gaaa ate= =and r._y rcuN iId b325 OOO py dty. p.r,�onon par d y st dasa�od In PuhAe GOAe, a <br /> per C awn��paMYsa UD�D fS,OPa I��mn pr dcy as d, iba In IE1kc <br /> WaLto 7 WAIZ�' h'Wrj . <br /> �elivery Count: ____ Date 6 �r�� [ ]Same As Hauler Poird <br /> u.a Wave 77ro Dallvsry Point Waste Tire Delivery Point <br /> WORK ORDER!MANIFEST V McCoy Truck Tire Service Center [ ]McCoy Truck The Service Center <br /> B50 Harlan Rd. 1537 E.Market St. <br /> 1274877,52 6 32 3 OB French Camp,Ca.95231 Stockton,Ca.9Fi205 <br /> TPID 01352986-01 Phone 209-982.0115 TPID 41778978-01 Phone 209-652-0434 <br />