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FORWARD <br /> SITE TICKET GRID <br /> INC0RP0RAT- ED / <br /> j7 ° )F-4 <br /> F- <br /> WEIGHmASTER <br /> 3999 South Austin Road/WEIGHING LOCATION P O Box 6336 <br /> ca, CA 95336 Stockton, CA 95206 i <br /> I (209) 982-4298/WEIGHING LOCATION Main Office (209) 466-4482 DATE IN TIME IN <br /> lesource Recovery (209) 982-4936 Fax (209) 465-0631 2/4 E. S i <br /> 7 i {`DATE OUT TIME OUT <br /> r ,4,5� �T-`^ �,� I� ��i h�� �4 ±t+t ALE !>m <br /> i j r f l i t ry 1 VEHICLE ROLL OFF <br /> ORIGIN <br /> 16 1.1 r= ;t1 Y <br /> 40 <br /> S'\(Ti 0uj r) ! F t iC i <br /> T A14E "1'1); i',H 1 00 1-111 <br /> flo - r r I � t 1 •+� r#�I IN <br /> QTY UNIT DESCRIPTION RATE EXTENSION TAX TOTAL <br /> `~ -tb y{,t ? ��4Yti ut RL rt #k. 1�1Lri ! C <br /> 1 <br /> WEIGHMASTER CERTIFICATE THIS IS TO CERTIFY That the following described commodity was weighed measured or counted by a weighmoster whose signature is <br /> on this cerMicate who is a recognized authority at accuracy as prescribed by Chopter 7(commencing with Section 12700)of Division 5 of the California Business <br /> and Professions Code administered by the Dtvlsion of Measurement Standards of the Callfomta Department of Food and Agriculture <br /> NET AMOUNT <br /> TENDERED <br /> CHANGE <br /> CHECK NO <br /> DRIVER'S SIGNATURE - r / <br />