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■■■c 06 09 12:43p Randy Powell 209-838-8604 p.1 <br /> ■� 1Z/V4/ZVVzj hb.9V rnn 4VJJ4I ��� ,.• - - <br /> ■ <br /> WORK ORDER!MANIFEST <br /> 1274877- 33588 <br /> Wast Tire Hauler <br /> McQc Truck Tire 5ervlce Center, Inc. <br /> Name <br /> y <br /> 1407 Lone Palm Ave. ddress: /4' <br /> Modesto. CA 95351 puG Ciry ��l�-yJ ;ate: <br /> 209-521-6221 Zio: Pho n e� <br /> T -1274877-01 TPIO with Suffix: <br /> Load Dale: load Type: hole [ ] Cub c Yard [ J r )Pound od <br /> Decal # - , � ick-up Count; <br /> �� 5tate� Cot cods: RWDY [ livery Count: <br /> Licen ------ -- <br /> SIZ9 MFG. DOT# TREAD WHEEL COMME,�TS _ <br /> 1 — t <br /> a <br /> 7 -- <br /> 8 — — <br /> 9 - ----- <br /> 13 <br /> --t3 - - ------ ---- <br /> 14 <br /> 17 — - — <br /> 20 <br /> Drivers Signature: A/ 0 Customer Signature: A 707c"111/7 )l Date: <br /> Drivers Name(W.4 Customer Name(print) <br /> I ce1111y that ardor penUNv foe undnr the Is.•a o:lha Stale or Cahrorrtla Ihai fie Inrormaaan I carLfy fief under peanit�of oe�ury ander.Fa Ww=of Nva�t:ara pl Callbmla rwl tna IrlorTptlan <br /> 09Yi0eC abma r.Caa ate Lein <br /> nada—.I am c wa;Tui(a 1010WQOn of Thls tn(a�maticn may Grovlooa 21)a Is the pad Dorno.In it 1113r.I am Pwpri Imel(ele�ICeh(H101 I NB rlbrraeGan may <br /> Ip4t;lr In TU Fp�.loa,ICt.DW ,or aanlal o1 wo,ol cr ihp'Npeb7 ylr8 Mpylat geglplrgtla�p'JTU6nl rVIVH c NI pgn3lae O up l0$25,00D oer 46y,par�IooajM of 62mlr,ias J' c oarahles vp w 15,000 <br /> 1 rho Nbhc P-a'—Cade bawl an 42080 en:mpy rar1h In rill oenddam vp to 5 000 GGer day. per vUeWi oar day as deaaEbad m NO.6osourt.o eoeo v.-on aap6i, <br /> per vtaotlen pr aaminlshaava panalllr.up IC Sn,ara par vialooan par aay aq aoaaleye In Pybrlc <br /> Reeovrca Cale Rota 42962. <br /> [Imported Load I Exported Load and _ocatier Hauler Exemp"on Status: <br /> Address: [ J Government <br /> [ ]LEA Exempt <br /> City �-- Stale: -�. ( jAgricultural <br /> [ ] Common Carrier <br />