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FORWARD SITE TICKET GRID <br /> IN COR PO RATED <br /> 9999 South Austin Road/WEIGHtNG LOCATION P O Box 6336 WEIGHMASTER <br /> a, CA 95336 <br /> 5tocktan, CA 95206 <br /> L (209) 982-4298/WEIGHING LOCATION Main Office (209) 466-4482 DATE iN TIME:IN <br /> Resource Recovery (209) 982-4936 Fax (209)465 0631 <br /> sSr C` l7 to y +y,+f; i a !ti ! DATE OUT r TIME OUT <br /> VEHICLE ROLLOFF <br /> *. rf.i• zt� + t <br /> 'R/ y , REFERENCE ORIGIN <br /> r _ <br /> s +.+� li�C 1z ) :a�i s illy ;_ � Td , <br /> i L <br /> QTS' UNIT 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 />:)n this certificate who�s a recognized authorly 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 AMOUNT <br /> TENDERED <br /> CHANGE <br /> �y CHECK NO <br /> DRIVER'S SIGNATURE <br />