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09/28/2015 14:36 2095 .81 MCCDY TRUCK TI, PAGE 04/05 <br /> WORK ORDER I MANIFEST <br /> 4877378530.5 <br /> Wade Tire Hader Waa P Tirere ator <br /> McCoy Truck Tire Service Center, Inc. Name: YCt*-A fAl <br /> 1407 Lone Palm Ave Address: 5 pfd 90/17 C(r <br /> Modesto,CA 95351 - `_ City- "CStatc: <br /> 209-521.6221 q <br /> Zip:_l S 3 0 �Phhoone;7p S *30 <br /> TPID-1274877-01 TPID with Suffix 6 ZQ7 �--y <br /> Load bate• Load T c: NYWhole Cobic Yard I I Ton Pound <br /> Decal # 5: -Q/Z,2 a I I MPick-up count:---_ <br /> License# Cit&At I State: CP1 Dot Code: RWDY [ ]Delivery count: <br /> EGULAR TIME O OVERTIME ( 1 CALL OUT CUSTOMER POp <br /> FLAT REPAIRS117' WHF_EL SWITCHES_ MT/DISMT <br /> LICE SEN09U31 Z6 VEHICLE MAKE. MILEAGE <br /> _JJ VEHICLE NO. <br /> �� <br /> LOCATION: Uoz Ov` <br /> WORK PCRFORMED`, y\ 4I1o� 6)' NtL) L.0 25- �Ce MILEAGE IN <br /> ll• MILEAGE OUT <br /> TOTAL, <br /> TIME IN <br /> TIME OUT �O <br /> 9SIZE MFG DOT ry TREAD WHEEL COMMENTSLie 4 , <br /> 2 777 <br /> 3 <br /> 4 <br /> 5 <br /> 6 <br /> 7 <br /> 6 <br /> Drivers Signature Date Customer S• nature. ' IDate; r U <br /> Orivors Nam rint Customer Name(print o <br /> I'a!Illy Ihat urdnr p•npllY of eerurV II.I•r I•to+:a Inn 61n1a of Cn I!o tMl IR•-—motion I rarity II171 urciar p.npl!r u!UeduyIIIW IM;■g dl Cllildn•lo rhm rl�,Koren ton <br /> Wev.End■bdv!It bu*and mrrarl.In*Jdllbn.I nm aw�ro that fnlafl:•unn n(I*Ve"(17MI an nay :o dnr•Ova„In:and eovrl m M:II*on,I n W.u•n M7C 1144 n nr m4 hfo•naron ma <br /> rMull Iq yu**on:on,mrnrnlq.l ur ddrlm Y InM.vpl ql the Warm Tiro 4�VIar RQp'.rlydl M Mo*VCN -*,411 ni Vl''.pyran'@on LO M t7,,n An//1r d, a H.lt rt•faIal Vn n In <br /> ro Ihq CI bid k.� R rad*aaallan dNgn na(11M1]y f*:Vii tit rIVII pglpl;lla up 10 T.7!r.00rI Y•DM Nol.0 n y <br /> J *a u9 D a',nnn <br /> rtr va1111Cn W adnli l• aliM)n,nll•a'I i:lf 4,:i An(,n*,V101n1Id11A dry a*da::rl*MI In f Wilk � nnr an n��nn o*r day oc nearrwr*d n pV711G Rnmi, ('.nA7',Vl AA �. <br /> arA'm Cod.—Am 42002. <br /> )Imported Load I (Exported Load and Location I Haulcr Exemption Staffs: <br /> s Address <br /> )Government <br /> City ( J LEA Exempt <br /> State: ( 1 Agricultural <br /> Common Carrier <br />