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FORWARD <br /> INCORPORATED SITE TICKET GRID <br /> 3999 South Austin Road/WEIGHING LOCATION P O Bax 6336 WEIGHMASTER <br /> ca, CA 95336 Stockton, CA 45206 !"Wil '' <br /> (204) 982-4298/WEIGHING LOCATION Main Office (209) 466-4482 DATE IN TIME IN <br /> to ce Recovery (209) 982-4936 Fax (209) 465-0631 <br /> t ti' `I ' DATE OUT TIME OUT <br /> in��"J <br /> VEHICLE ROLL OFF <br /> REFERENCE ORIGIN <br /> M � , <br /> -i •1rT .vLa :�} _f �, �:r^.P� 'int, s1� i1�._�'J�F rSrI "' �>u � w r� � ti .�f'�1 <br /> N a41 <br /> CITY UNIT DE=SCRIPTION f RATE EXTENSION TAX TOTAL <br /> � D p-6q <br /> NEIGHMASTER CERTIFICATE THIS IS TO CERTIFY That the following described commodity was weighed me or counted by a wafghmaster whose signature is <br /> In this certificate who is a recognized cuthorlty 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 Agnc0uro <br /> NET AMOUNT <br /> TENDERED <br /> CHANGE <br /> CHECK NO <br /> DRIVER'S SIGNATURE <br />