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;02 209-521 31 MCCOY TRUCK TI PAGE 10/14 <br /> 11/03/2011 13 <br /> IV vvt�rtn vRv�r[r Iv1M1Vtrea r <br /> 7 1274877- 59433 <br /> McCoy Truck Tire Service Center, Ina Namo: <br /> ��� & <br /> Address: <br /> 1407 lAnrx Palm Ay 7�c�e, /fes' UUU <br /> Modesto.CA 96361 %% City:,Tf Q C/ 9t®ta= <br /> 209,521.6221 PQ1- Zip; Phone:16 3*5—0'/6 <br /> TPID-1274877.01 iTPIQ with Suffix: <br /> Load Date: "�-�� �� Load T e; Whole Cubic Yard Ton Pound <br /> Dscwl r - 1 <br /> wick-up count= <br /> License 4:V Z stagy: R I Dot Godo: RWDY [ ]Delivery count'. <br /> F(REGULAR TIME [ ] OVERTIME [ l CALL,OUT CUSTOMER PO{f <br /> FLA?REPAIRS WHEEL SWITCHES MTlDISMT <br /> LICENSE NO. u VEHICLE MAKE MILE4QE VEHICLE NO. A./ 4/ <br /> LOCATION: I D h � � <br /> WORK PERFORMED: �,,�,�,; <br /> ------- + �1 <br /> MILEAC3E <br /> OUT <br /> _....,_,... <br /> TOTALAf <br /> - <br /> n 4/1) TIME IN. --� <br /> - <br /> _,.,.._._.. . TIME OUT <br /> SIZE_ MFG. DOT# _ TREA_ b WHEEL COMMENTS <br /> 4 <br /> 7 <br /> B � <br /> prlv®rs Si nature: Customer&i natur2: Date: <br /> t <br /> Drivers Name (int ^ Customer Name flnt <br /> I caraiy det�ri0•r ony of w�lon.�.+•r m.i.w,m mo f�Rna M uromw mnl Ino mrvr.�o• t 11 <br /> rIM uneW <br /> proroPyoetlruvt�laMdt oIPnId�uatlOouotbnn!0opoAgmfemtabAtom►fvMlur,aeeroobRa�GrMomawCbwmlaBnvneoo.anoroltro.NMndIMe•entedbtdpi laallai ,I"ym oI mweSs q dvMmrotcsrvtne rte n d MRIS h,lemd,etleR 1A^^YAforawlRdadMd ll 0ynpnnymr verlury k2�N �o <br /> Y' p! Mmp"duy � brurfA Cnla 9nc1eaonm1lticl in�oeMn <br /> .two-W 1140 <br /> hV0.R byw Clfrodln¢20Bl�4hn-6of2 n�Mu <br /> o�lr1tent�mntrem mmnutOdInRltraeiRr5m6ao10tl0rto0n1e <br /> � <br /> rw dry nv dvpeAbetl M dud o <br /> R�rouoo Cada N.+allnn�tlR01C , <br /> [ �Imported load [ ]EHauler Exemotion Status:xported Load and Location � [ ]Govemmant <br /> Address- I l LEA Exempt <br /> P Clry State: ( ]Agricultural <br /> I Common CeKler <br /> Received Time Nov, 4, 2011 1 : 21PM No. 2465 <br />