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11/03/2011 13:02 209-521 1 MCCOY TRUCK TI PAGE 13/14 <br /> s <br /> ' WORK ORDER J MANIFEST <br /> d <br /> 1274877- 3 4 4 2 <br /> Wog fg Tirs Hauler <br /> McCoy Truck Tire Service Center, Inc. Nome: <br /> 1407 Lone Palm Ave. �� '� Address;�� � <br /> Modesto,CA 95351 City_- State: <br /> 209.521-6221 Zip: qS' Phone; <br /> TPID 1274877-01 TPiD With Suffix: <br /> Load Date: Lood Type: Whole [ j Cubic Yard on Pound <br /> Decal # - . O ]Pick-up Count: <br /> License#: Stste: Dot code: RWDY 0e1ivM Count:— <br /> I MIto, DOT# TREAD W - COMMENTS_. _ <br /> z JlAe -- <br /> 3 <br /> 4 <br /> 7 <br /> 12 <br /> 14 <br /> 16 - <br /> 17 9 <br /> 19 <br /> 20 c// - •--- - <br /> Dryers Signature: Customer 5tgn"ire: Date: <br /> Drivers Neme Customer Name dnt <br /> undr roily of e 1 a Iowa f d-9k& I CalKonla;hat Rio.,xn�oan 10*oamry rtu[uMer p� pr alp( d Ihs of CaINanNe drat dt o In/ortr»Mon <br /> peo�or+R�lhbdpuaaEae la Dia erd onnea.n oderYaan,I aT awQa that fat■tdndbn of WAn tr�bmwovl msp POrfOeO eDOVe b WS n id r�1 oat vweia Rat+bbRlurfan of Mb,nMrtquMorl <br /> rvmN 1nrBvwnm=n nnmo9 3n.Q o. Df nonmW of pb w■ft 7Me HMer Rapy��jp�t nl Mwft eMl pena,1w, uP b ' ppb W g wpelten s '".-O wDr a p�nplm uD " <br /> to IrN�.�udlo��e�ouiw Pr�i0yeoe�c0o�x2600 anE w�eeu1 In,ull ve�+M�ea w to 9Z7.00� dwy. P'R vtol'rtl�+^Ver any e�n�eween In prr ie Aesairor OiMe exUon X2862. <br /> R4+oWoo Coda n l6n 41Sp oondtlon un 1e 00000 oor vltlellan par d"as deurad In t�ft�dln <br /> kft <br /> .o►* [ ]Imported Load ] I Exported Load and Location Hauler Exemption Status: <br /> fA <br /> Address: [ ]Government <br /> � [ ]LEA Exempt <br /> City State: [ ]Agricultural <br /> - ]Common Carrier <br /> Received Time Nov. 4, 2011 1 : 21PM No- 2465 <br />