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FORWAI�- D <br /> INCORPORATED SITE TICKET GRID <br /> l M- <br /> 1999 South Austin Road/UVEIGHING LOCATION P.O. Box 6336 WEIGHMASTER <br /> Va, CA 95336 Stockton, CA 95206 <br /> (209) 982-4298/WEIGHING LOCATION Main Office: (209) 466-4482 <br /> e Recovery:(209) 982-4936 Fax: (209) 465-0631 �' ` I"t_Ir'!CE <br /> DATE 1N TIME IN <br /> 6Z1241 1 <br /> Iw)�t�14CtED C' EO E—l-4V T R0t.ii'fE t1Tr=;€_ z_s i i'i c:i," 'i i a:56 <br /> IIICi-? EI_ €€ir USER DATE OUT TIME OUT <br /> r��::.; t•J. i`�E��:(�;t� t._:A.i:�;w« ... Wit!�r:'}'% <br /> -;t, <br /> VEHICLE ROLL OFF .11 REFERENCE ORIGIN <br /> ,N`i..,:;i�ti :-'i ti'�" =: :'J EC}. .-1i 1 ,.,,..,-1Y:•-ie_1 1..�_"� r.ir�i._Eiir.. -... j�il_'J 4a F= 'w ,f i.= }=.t. �. <br /> 4.- vJ_- 1.t;1't 3' ., >w ''•-l•1.r {._.FN` . <br /> QTY DESCRIPTION AMOUNT <br /> ..:;% . . . }�;J r;•.��y, is i' ��. ��r:a_ -�=-r ;)fit=. <br /> WEIG3IMASTER CERTIFICATE THIS IS TO CERTIFY That the following described commodity was weighed,measured,or counted by a weighmoster,whose <br /> signature is on this certificate,who is a recognized authority of accuracy,as prescribed by Chapter 7(commencing with Section 12700)of Division 5 of <br /> the California Business and Professions Code,administered by the Division of Measurement Standards of the California Department of Food and Agriculture. <br /> i. G, 2Ll` NET AMOUNT <br /> •'�-�; r-,�, acry•r- —-••�: - <br /> TENDERED <br /> .: ... ..�'s-j i_.r i �= ._."+ �'t_'_Ei =., A?-i c S.�''. c.�.i _ L=? .-I .. _.. � - i`S ..�•. .•i:t- .4 .:i..� . .. .. .i . <br /> Cal. ! <br /> CHANGE <br /> DRIVER'S SIGNATURE X ���recycled paper <br /> F43-C957LT <br />