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FORWARD <br /> SITE TICKET GRID <br /> INCORPORATED <br /> ' Y J <br /> WEIGHMASTER <br />)99 South Austin `:OACI/WEIGHING LOCATION P O Box 6336 <br /> CA 95336 Stockton, CA 95206 <br /> n� - <br /> (209) 982-4298/WEIGHING LOCATION Main Office (209) 466-4482 DATE IN TIME iN <br /> source Recovery (209) 982-4936 Fax (209) 465-0631iris <br /> DATE OUT w TIME OUT <br /> r <br /> ROLL OFF <br /> VEHICLE <br /> Y <br /> f } + 1 ir1nEf " REFERENCE ORIGIN <br /> QTY UNIT DESCRIPTION RATE EXTENSION TAX TOTAL <br /> r Y <br /> lEIGHMASTER CERTIFICATE THIS IS TO CERTIFY That the following described commodity was weighed measured or counted by a weIghmaster whose signature is <br /> n this certificate who is a recognized authority of accuracy as prescribed by Chapter 7(commencing with Section 12700)of Dmsion 5 of the California Business <br /> nd Professions Code administered by the Division of Measurement Standards of the California Department of Food and Agriculture _ <br /> NET AMOUNT <br /> TENDERED <br /> MA 1 I'!!rc' r f <br /> CHANGE <br /> CHECK NO <br /> DRIVER'S SIGNATURE - <br />• <br />