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(J�t)f F0RW RD SITE TICKET GRID <br /> I N C 0 R P 0 R A T E D <br /> 9999 South Austin ROad/WEIGHING LOCATION P O Box 6336 WEIGHMASTER <br /> 953.1&, Stockton, CA 95206Lfa, CA <br /> (209) 9874298/WEIdIFUNG LOCATION Main Office (209) 466-4482 DATE IN TIME IN <br /> Rce Recovery (209) 982.4936 fax (209) 465-0631 Vq) It 4 <br /> DATE:OUT TIME OUT <br /> T( i ' Fay rt Vi,d1 = }'p , T't,l <br /> Y+MI, L N;'7 ." VEHICLE ROLL OFF <br /> 17 6 REFERENCE ORIGIN <br /> "ft'� . L <br /> l1r41�Fly, <br /> ( 137anwe <br /> Yf >v.> 11B Z'(1 5 'rF 3 <br /> QTY UNIT DESCRIPTION RATE EXTENSION TAX TOTAL <br /> 1x It,j r "'LA5 S 1 T t''01 Ls <br /> ����f <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 certificate who is a recognized authority of accuracy as prescribed by Chapter 7(commencing with Section 12700)of Division 5 of the Colrfornia Business <br /> and Professions Code administered by the Division of Measurement Standards of the California Department of Food and Agriculture <br /> NET AMOUNT <br /> TENDERED <br /> 'AA Y_"s,..'I' X39 <br /> CHANGE <br /> rj CHECK NO <br /> �' r <br /> DRIVER'S SIGNATURE <br /> r� <br />