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FORWARD "-SITE TICKET GRID <br /> INCORPORATED <br /> WEIGHMASTER <br />)999 South Austin Road/WEkGHING LOCATION P O Box 6336 <br /> a, CA 95336 St--kton, CA 95206 <br /> (289) 982 4298/WEIGHING LOCATION Mdm Office (209) 466-4482 DATE IN TIME IN <br /> to ice Recovery (209) 982 4936 Fax (209) 465-0631 <br /> r y w Ct9 /`v DATE OUT TIME OUT <br /> ` <br /> L "° Q },t <br /> iTj b VEHICLE ROLL OFF <br /> � ) REFERENCE ORIGIN <br /> [ r>>I i _ is iyt <br /> QTY UNIT L DESCRIPTION RATE EXTENSION TAX TOTAL <br /> NEiGHMASTER CERTIFICATE THIS IS TO CERTIFY That the following described commodity was weighed measured or counted by a weighmoster whose signature is <br /> Dn this certificate who is a recognized authority of accuracy as prescribed by Chapter 7(commencing with Section 12700)of Division 5 of the Callfornla Business <br /> end Professions Code administered by the Division of Measurement Standards of the California Department of Food and Agriculture _ <br /> NET AMOUNT <br /> TENDERED <br /> CHANGE <br /> r` <br /> CHECK NO <br /> r � <br /> DRIVER'S SIGNATURE <br />