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(t) FORWARD SITE TICKET GRID <br /> INCORPORATED —I_ _aIA L% <br /> WEIGHMASTER <br /> 91999 5Ifutla rust Road/WErGHING 'OCATION P O Box 6336 <br /> 1t a,CA 93:336 Stockton,CA 95206 ``'a "_1 <br /> l#r (209) 982-4298/WEIGHING LOCATION Main Office (209) 466 4482 DATE IN TIME IN <br /> 2e ce Recovery (209) 982-4936 Fax (209) 465-0631 <br /> ra DATE OUT TIME OUT <br /> qq^ [[ 11 <br /> t(� Y 4, . I I 'i <br /> ca x VEHICLE ROLL OFF <br /> t w ar { 21 <br /> V 4�k✓!' 1. �1' t✓ �`� .{. <br /> "hu; t.I f:, <br /> REFERENCE ORIGIN <br /> 4 <br /> � ' <br /> I,. ��4trY <br /> qt a <br /> ��. ( `;i?,s� <br /> 1 4'41 <br /> u <br /> QTY UNIT DESCRIPTION RATE EXTENSION TAX TOTAL <br /> oil <br /> (//^+ <br /> ,ti z I <br /> r <br /> IGHMASTER CERTIFICATE THIS IS TO CERTIFY That the following described commodity was weighed measured or counted by a welghmaster whose signature is <br /> 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 /> an¢Professions Code administered by the Division of Measurement Standards of the California Department of Food and Agriculture <br /> NET AMOUNT <br /> TENDEFtED <br /> CHANGE <br /> r <br /> CHECK NO <br /> DRIVER'S SIGNATURE r �� <br />