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d FORWARD "SITE TICKET GRID <br /> INCORPORATED F ' <br /> X999 South Austen Road/WEIGHING LOCATION P O Box 6336 ,m � � , , WEIGHMASTER <br /> Verce <br /> a,CA 95336 Stockton, CA 95206(209) 982-4298/WEIGHING LOCATION Main Office (209) 466-4482 DATE:IN TIME IN <br /> Recovery (209) 982_4936 Fax (209) 465-0631 _ , r r ��� r,; <br /> ry <br /> DATE OUT TIME OUT <br /> r„T ,+, tie5'', j ;t.l iY I .tf—s f"41 <br /> VEHICLE ROLL OFF <br /> Y7 I I <br /> '1- " <br /> {s -x' + ,.' f}�}.;h f `�' C wi �ti/ REFERENCE ORIGIN <br /> r, —j <br /> Y Y+ , <br /> %S. 1 ' k. S ... �^`f . ..` x ''l J;.., d I ✓F !t�, J - t t <br /> OTY UNIT DESCRIPTION RATE EXTENSION TAX TOTAL <br /> r t a� I r E t' I 's l ' �t � �;' I- . 3 <br /> NEIGHMASTER CERTIFICATE THIS IS TO CERTIFY That the following des&bed commodity was weighed measured or counted by a weighmaster whose signature is <br /> Dr this certificate 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 Agriqulture _ <br /> NET AMOUNT <br /> TENDERED <br /> CHANGE <br /> CHECK NO <br /> 1 <br /> DRIVER'S SIGNATURE <br />