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FORWARD TICKET GRID <br /> INCORPORATED ! T _C_ra <br /> 999 }h Austin Road/WEIGHING LOCATION P O Box 6336 ! � I(J�_ <br /> Man , CA 95336 Stockton,CA 95206 <br /> Landfill (209) 982-4298/WEIGHING LOCATION Main Office (209) 466-4482 DATE IN TIME IN <br /> Resource Recovery (209) 982 4936 Fax (209) 465-0631 f E n r , I <br /> }r DATE OUT TIME OUT <br /> �_ - <br /> t, 1` l{{ih11_ r VEHICLE ROLL OFF <br /> �,�_ y � f, Wr-r n�--1-�` L REFERENCE __t ORIGIN <br /> W=, —Ahs ' i„.D2rti i = t+ "�i_iitJ <br /> t8 r ]— ' if'21!,ac <br /> QTY UNIT DESCRIPTION RATE EXTENSION TAX TOTAL <br /> { <br /> yF I `;tel s F T'i t I])-, <br /> WEIGHMASTER CERTIFICATE THIS IS TO CERTIFY That the following described commodity was weighed measured or counted by a welghmaster whose signature is <br /> on this cerflflcate who is a recognized authority of accuracy as prescribed by Chapter 7(commencing with Section 12700)of Division 5 of the California Business <br /> and Professions Code administered by the Division of Measurement Standards of the California Department of Food and Agriculture <br /> ^[ NET AMOUNT <br /> ' <br /> fir; 1 1-..�. ." 3 T , -• j tJ <br /> i' awl' TENDERED <br /> iii - C1 Lr =C +. , „ ; �� ; i'�_ i'1 ;s t l CHANGE <br /> 31A irr_ <br /> CHECK NO <br /> k f 4ft recycled paper <br /> DRIVERS SIGNATURE <br />------------------------------ ------------ <br /> r <br />