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09/28/2015 14:36 2095 281 MCCOY TRUCK TI. PAGE 05/05 <br /> I t r r WORK ORDER/MANIFEST <br /> 1274877- <br /> a' Z 9A <br /> Waste Tire Hauler Waste Tire Generator <br /> McCoy Truck Tire Service Center, Inc. Name:Y5A r/ Cft,¢c �y. — NSC <br /> 1407 Lone Palm Ave. Address;)If ob eo,111 pe <br /> Modesto.CA 95351 <' ' Cit pfC.V State<^� <br /> 209.521-6221 Zip "s(''n7 Y, Phone _�. <br /> TPID-1274877-01 TPI wltM1�uf "7 70 <br /> Load Date - Load Type, ( , Whole [ ( Cubic Yard Ton ( j Pound <br /> Decal # �-D / <br /> [ ck-up Count: <br /> Lice a#: v140F' State: �� Dot Code RWDY `— <br /> [ REGULAR TIME ( J OVERTIME CALL OUT CUSTOMER POO <br /> FLAT REPAIRS_ WHEEL SWITCHES MTIDISMT�_ <br /> LICENSE N0 �nn e <br /> 7�D VEHICLE MAKEMILEAGE�_ VEHICLE NO.�pZ <br /> LOC <br /> ATIO� r'— <br /> WORK PERFORMED, / MILEAGE IN <br /> ,)r,r �"C�e7 �, MILEAGE OUT <br /> (� TOTAL. <br /> 7-0 5 Gi 6)F' <br /> TIME IN <br /> TIME OUT <br /> SIZE MFG DOT# TREAD WHEEL COMMENTS <br /> 2 <br /> Drivers Signatur Date: -ON ustomer Signature; Date: <br /> Drivers Name(print Customer Name(print) A - 1 <br /> I—;1 fy 1h�1 uTw P-my-1 rmri^urow Inn I•Me of In '"'o f co6f Lt I tth0 In m pp <br /> wded rarmn 1.1".-1,0 conn[<.r1,urOpy- I am Bwrm rnpr•1 1 1:nrtpr Inns r•1,It p +Iry a ,n r Ine I,w.-or n 411,1- (,.tlbrnla X4.1 r1,-Irr <br /> 1,!I GOiln'Of 11,1'1."IMA110a m]Y C'n Vor <br /> •n:.Mr n n 1,c! b rO w on,n•{rtnl7l of Innnwn 1,t rh Wa; pnnrld•ll 9Y�w Irurr nrvl nn 1. 1,addibn,r nm nwn 41,1(a L.hent on a(In n1(pm'CIIOn Rny <br /> nrnn naol!e so.,ren CnA.111.1o'...1100, <br /> a to rTll+re Hover a/glYlradon purtunnr ,n•yll uvll Dnmlcn+r In f•?.a 000 onr a• r vbinl'on or oamn'+Im(Ww rynn'tk;vo to t5,tY1(1 <br /> I v rnsd �2W0 nwl r•;+rnr10'.n ave 1,a• to 5Y.090 ppaay d•Y. ucr vont on r rl• P y <br /> pp Iti nU or nemw•pnlw!ponaon:up In 1.5.0')6 Dor+.etal'a.+1,H 1,y 1,e r DM n r'nld6•. r1, Y:'d do:urnn In o,eUlr,riseovx e0tln nnnttwt•Q99'[. <br /> R;=r 'nd-gc0on 429,2 <br /> [ livery Count: sto The Delivery Point <br /> De <br /> —__ Date - _ Samo As HeulPr <br /> WORK ORDER i MANIFEST <br /> so���'y`t•,r7 Waste Tire Debvcry Point Waste Tire Dellvery Pelnt <br /> McCoy Truck Tire Scoilce Center I J McCoy Truck Tire Service Center <br /> 274877- , �g o = 10850 Harlan Rd, 1537 E.Market St. <br /> French C>)mp,C.I.95231 Stockton,Ca 95205 <br /> TPID#1352986.01 Phona 209-982-0115 TPID#1778978.01 Phone 7D9.652.04.34 <br />