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FORWARD6ITE TICKET GRID <br /> �b INCORPORATED � ; <br /> X999 South Austro Road/wl:iGHINc LocATlofv P O Box 6336 ' <br /> WEIGHMASTER <br /> 4 a, CA 95336 Stockton, CA 95206 f '��'kC� <br /> (209) 982-4296/WEIGHING LOCATION Main Office (209) 466-4482 DATE IN TIME IN <br />'es rce Recovery (209) 982-4936 Fax (209) 465-0631 2 thf�P H '?C'1 � ; �? '� <br /> "C,1s,f"! ' DATE OUT pY ^� TIME Ot1T <br /> LIP E(A-1 ( EN'' 1 riUi4��'r�� `;r L. � �Ir�k���� �l3tiJ�� � � � 'f l <br /> 1'N i 3a VEHICLE ROLL OFF <br /> 7 i 1NO G12 I <br /> REFERENCE ORIGIN <br /> .Cl f\iT�-9 M4 1 'S r 1 l 1 1 <br /> �l i s <br /> wY�� 3.wr5 <br /> T C� t.lrif�i � h,. ,+ ;7 ✓ 3 i !k <br /> QTY UNIT DESCRIPTION RATE EXTENSION TAX TOTAL <br /> � 1 <br /> f, I <br /> STD�b ODk <br /> dEIGHMASTER CERTIFICATE THIS IS TO CERTIFY That the folloWng described commodity was weighed measured or counted by a weighmoster whose signature is <br />,n fts certificate who Is a recognized outhady of accuracy as prescribed by Chapter 7(commencing with Section 12700)of Division 5 of the California Business <br /> ind Professions Code administered by the Division of Measurement Standards of the California Department of Food and Agriculture _ <br /> NET AMOUNT <br /> TENDERED <br /> CHANGE <br /> CHECK NO <br /> DRIVER'S SIGNATURE .rte' ��"r 1_s L <br />