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FORWARD "-S�ITE � TICKET GRID <br /> INCORPORATED w` w <br /> WEIGH ASTER <br /> 3999 South Austin Road/WEIGHING LOCATION P O Box 6336 <br /> a, CA 95336 Stockton, CA 95206 "' " <br /> es urc (209) 982-4298/WEIGHING LOCATION Main Office (209) 466-4482 DATE IN TIME IN <br /> te Recovery (209) 982-4936 Fax (209) 465-0631 <br /> 7{ f, jr DATE OUT TIME OUT <br /> -'4,ry `S` /` � — 1 <br /> �f I .a iia r�e � �. s r f .. <br /> .sf_'=:'' ROLL OFF <br /> VEHICLE <br /> z' ZV''w` =`s `1' A � <br /> t*_L, i REFERENCE ORIGIN <br /> e' 7i%y�.�f'- '. rf ft -s .r'� S'_�J lxa] Fly' ~ �>_5a1r 3r yS�r rY` J <br /> 0,' In _ ` <br /> a <br /> QTY UNIT DESCRIPTION RATE EXTENSION TAX TOTAL <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 California Business <br /> and Professions Code administered by the Division of Measurement Standards of the California Department of Food and Agriculture _ <br /> "NET A OUNT <br /> . TENDERED <br /> CHANGE <br /> CHECK NO <br /> DRIVER'S SIGNATURE <br />