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11/03/2011 13:02 269-521 1 MCCOY TRUCK vvTI PAGE 11./14 <br /> ® e uKK VKuI:K/MANIFEST <br /> 0 0 ig 127 4877- 58342 <br /> Waste]�n® auler Wage_Tira Qgnerator <br /> MoCoy Truck Tire Servlce Center,Inc. Name:pteN AVM QIQ05. <br /> 1407 Lone Palm Ave. Addre� Op1��1c5 Qom' Q (,t,' IE, 4 <br /> Modesto,CA 95351 City iQ •� Stat®, <br /> 206-521-6221 �1�� ' Zip. cvS Phon9; <br /> TPID,1274877-j TPlo with Suffix: <br /> l,ond l}abe. — 1 Load Type- Ail Wh012 Cubic YorU Ton Pound <br /> Decal .�. -�l L g. Pick-up count; - <br /> Li0en6e# j State: C,-VO, Dot Cod®: RWDY [ ]Delivery count: <br /> REGULAR TIME OVERTIME [ I CALL OUT CUSTOMER POSE <br /> FLAT REPAIRS WHEEL SWITCHES .-�� ,�MT/OISMT <br /> LICENSE NOkWS%1" `VEHICLE MAl EIMMILEAOE VEHICLE NO. <br /> LOCATION: '6 1 y0.cwnt+r, <br /> WORK PERFORME _ `S �Of� "� �IS�Q O MILEAGI"IN <br /> MILEAGE OUT <br /> TOTAL <br /> TIME INTIMEOUT <br /> TREAD <br /> ,51zE .. ..,. ,MFG, .. .DOT# WCOMMENTS <br /> .. ,......._,,..... . ..,...... ...,,_.. <br /> 2 <br /> 3 <br /> 4 _. <br /> 5 <br /> 7 <br /> 8 <br /> Drivers Sl natu Date*-J'5-11 Customer Si aturA: Date: <br /> Drivers Name EFInQ Customer Name(print) <br /> I dta u pf pottwalry a1 pDr1uM An lawn of Ihn faM d Co1MaMn Mt�f MM InrarmpMln I OT Y 1 urdm M of w!lury undar mo low.of dw 9tepl of Cauomlp 914f Me 111WmAnrA <br /> proV Ilppv�PO ttttt and oenoGG in pd0A0n,I am rMnm ttM fitl(bA17n pf ONS kf brtngllnn mry i��' N N Inge eta tot etl.In oddibon,1 am aware thin faimmobn of INA NTftnlNAlpn�1�e <br /> tea et In ouepon+bn,nrrourMon,or dmlaf 0!errwel of Mtlr WuiM TVA MttUlAIM RfQ1 11 pu!tKi nl nnul wnptt v�w a7 Za, per ary,per wmnm or�emnym�tluw MKfle uo i* <br /> At1.000 y <br /> b Itta Punlh Ratn!rrol 40M q�dl0n<'�(1�(�Q,MtAY ADUII IIf qNH pfllNlya up Ip929 I peer day, pa e� n per erry wn erwm ewe fn wuoflr.Rm�,v�Cade e!Ndn 4Z9e <br /> pryp.M"y�' (dMlon Of edminlebeUve pemm� w b 9'COQ per violation per Cay ac dacclbod In f�iDna <br /> RDsanco Coda^Aflddn 13962 <br /> 1Defa [ I Imported Load [ ]Exported Load end Looatl0n Hauler Examption Status: <br /> Address: [ I Government <br /> [ I LEA Exempt <br /> City State: [ ]Aorloulturel <br /> Comman Carrier <br /> Recelved Time Nov, 4, 2011 1 . 21PM No, 2465 <br />