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11/03/2011 13:02 209-521 1 MCCOY TRUCK TIR PAGE 14/14 <br /> V <br /> VE) <br /> WORK ORDER 1 MANIFEST <br /> 1274$77- 4 0 3 3 5 <br /> Waste lire Hauler <br /> McCoy Truck Tire Swvl ce Center, Inc. Name: <br /> 1407 Lone Palm Ave. Address: <br /> Modesto,CA 95351 ,PN '1 $ r City: 711�laQf - <br /> 209-521$221 Zip: Phone: <br /> TPID-1274877-01 TPID wftl•f Suffix: <br /> Load Date: ,l� Load o: ]whole C Cubic Yard I Tqn I I Pound <br /> Decal # - Pick-up Count: O <br /> Licen Q 3tata: Dot Code: RWDY [ ]tivIlvery Count— <br /> SIZE <br /> _ <br /> SIZE MF©, DOT# TREAD_ W _ CO_MMENTS <br /> 4 <br /> 7 <br /> 9 <br /> 9 <br /> 10 � <br /> l <br /> 12 <br /> 13 <br /> 14 <br /> 15 1 <br /> 18 <br /> 17 <br /> 18 <br /> 19 <br /> 201 IL <br /> Drivers Signature: J� e: ` Customer Signature: Date: <br /> Drivers Name rlN Customer Name(pAnt <br /> I eelttrr IMt arida.pe+fdh of er&M or um M"or C ffaw la awl ay In"I04 t ceAN them un0ef Der0 of/spry UR ser ft Ims of the afft of OnI"M"wP Ru+V+brt+eMbn <br /> pivNtlod aho.0 V true wrd In waafmn,I e m eWel�MN�Con or la fnlame0al may Ofo•ldetl suers b Irue aIM mnoat Ifl edrabon•I eln�fwrr1 IMt d On of IRN Itlbn Ivey <br /> Medea n 26VP M w%f1��'io0d��el��O�rp��/tlO_VOrRIQe�nleflr�dlyl Of tRe Mauler Ibn txrrp�t Iesuh cillo ponolaon up to�t9,000 far Norltlen p►�!n eneA�uo 10 000 <br /> Qk ael fl IAq d110C 10t1R!1eNh In tall Vona 9 W lO 7d.pDp q7r W1'. p4f Nddl�On ppr DIy OII�OfpY1 M pl �aUaOa eelllen <br /> Ra�aa e0ad��a flflalMn w o0 <br /> , par ft~am ea e.r�pAaO h P1JOItl <br /> low* [ ]imported Load Exported Load and Location Hauler Exemption Status: <br /> at Address: ( Government <br /> [ ]LEA Exempt <br /> City StaW ( ]Agricultural <br /> [ )Common Carver <br /> Received Time Nov, 4, 2011 1 : 21PM No. 2465 <br />