Laserfiche WebLink
• 09/28/2015 14:36 2095. _181 MCCOY TRUCK TI, __ PAGE 03/05 <br /> WORK ORDER J MANIFEST <br /> — O <br /> 1274877- 7 "0 4 2 A <br /> Waste Tire Hauler Waste Tire Reperator <br /> McCoy Truck Tire Service Center, Inc. Name: <br /> 1407 Lone Palm Ave, ^�, Address: � Ne- `C <br /> IN <br /> Modesto, CA 95351 <br /> City: �/ State: <br /> 209-521-6221 �': Zip:, ( P�hone: <br /> TPID 1274877-01 TPI It uf1 )' <br /> t6 C 0 -6 J <br /> r-^ <br /> Load Date: Load Type: hole ( ]Cubic Yard [ Ton ( ]Pound <br /> Decal # - j2f Yt <br /> ick-up Count: __ �, <br /> License#: state: Dot Code: RWDY <br /> SIZE MFG. DOT TREAD WHEEL COMMENTS <br /> 1 <br /> 2 <br /> 3 <br /> 4 <br /> 5 <br /> 6 <br /> 7 <br /> 8 <br /> 9 <br /> 10 <br /> 11 <br /> 12 <br /> 13 <br /> 14 <br /> 16 <br /> 17 <br /> 18 <br /> 19 <br /> 20 <br /> Drivers Signature: -4nDate: Customer Signature: V1 date: <br /> Drivers Name(print) Customer Name(print) <br /> .r Of"If Ih.t„r dor o-11 wrygvry a o •o d 'p Pal the lnrerm•11on +Gnlfy Ihat u,dor penmry nr pmp.h pPtl4✓the lewe Cf!nn su!•nr cp'Irowa Ihet tho nio m., <br /> Mldod a�awt::Iruunr/Se/'!d In Jdd;Ilor.I Mq Nvrp IhM h/Ipallon 011h1[nrormotlon mill prod7od aecv l•Md•.nn r,ryeGl in odallon,I•m mr•y IPpI 41101e110n of IN,wafm•llnfl wy <br /> vaeu m w.p•n..on,nvetelbn.or do,'nl or mnov1 of Iho Waste TIT Nau'nr q•4trlDo•+oma0nnl rowu r.1Nl p•nglllt lm ie Ski 007 enr e• o•r v10'p Uon tr odminlavlH•p•vu•.pp It�g,p00 <br /> +v mil <br /> Puble PosOur;o COCn,ntt'nn 17p6D 1,d nr;rcsull In Gvn p—mil UD W 525 000 err dny, pr�lMnllo�oot tm n:dn•cnn•n In F'NlfI Peloun:lI Codn.•rnh.ion a Ne <br /> Oer.lobio,or namnlr,lnln.ryrplUee oe+o S7.Ooj p+vorton n+r dar ae deot'looa in Punu� <br /> osowe.COfu��tGon 42GE2 <br /> belivery Count: _'_2 Date — O Waste Tire Delivery Point <br /> I [ I Same As Hauler <br /> WORK ORDER f MANIFEST o°"vp4r� Waste Tre Delivery Pont Waste rrre Delivery Point <br /> McCoy Truck Tire Service Censor I McCoy Truck Tire Service Center <br /> r ;� r,, W 10850 Harlan Rd. 1537 E Marker St. <br /> 1274877- ,` (�} 2 B French Camo,Ca.95231 Stockton.Ca.95205 <br /> TPID#1352986-D1 Phone 209-DB2-0115 TPID N1778978.01 Phone 2a9-652-0434 <br />