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FORWARD <br /> 51T& TICKET GRID <br /> INCORPORATED � '2,-� <br /> 99 uth Austin ROad/WEIGHING LOCATION P O Box 6336WEIGHMASTER <br />'W( <br /> < CA 95336 Stockton, CA 95206 �' r, r r <br /> n (209) 982-4298/WEIGHING LOCATION Main Office (209) 466-4482 DATE IN TIME IN <br /> source Recovery (209) 982-4936 Fax (209) 465-0633 �i s� -'"'M 4 f ►!'f; <br /> Pi`'rte.,r DATE OUT TIME OUT <br /> t� l F t..f 4Jft <br /> IN is "o'R;,� VEHICLE ROLL OFF <br /> REFERENCE 4 OR <br /> 2. _'•ryil•e- v: {7iLr . j. 1. � i .r;, �{fives _ tit�Y{LE kvT <br /> 11;J T <br /> QTY UNIT DESCRIPTION RATE EXTENSION TAX TOTAL <br /> i1rS <br /> .r E <br /> EIGHMASTER CERTIFICATE THIS IS TO CERTIFY That the foliowing described commodity was weighed measured or counted by a welghmaster whose signature Is <br /> i this certiflcote who is a recognized authority of accuracy as prescribed by Chapter 7(commencing with Section 12700)of Division 6 of the CaVornia Business <br /> id Professions Code administered by the Division of Measurement Standards of the California Department of Food and Agriculture <br /> NET AMOUNT <br /> • TENDERED <br /> f <br /> CHANGE <br /> CHECK NO <br /> 1 r <br /> DRIVER'S SIGNATURE �� <br />