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11/03/2011 13:02 209-521-& MCCOY TRUCK TIRF PAGE 02/14 <br /> 0 � <br /> WORK ORDER!MANIFEST <br /> 1274877- 359 5 5 <br /> WactA Tire H Itlar Was, .Tore Ganera <br /> McCoy Truck Tire Service Center, Inc. Name: <br /> 1407 Lon®Palm Ave.��� Address: <br /> r <br /> Modesto,CA 953W City: State: <br /> 209.521-6221 Zip: a : Phone: <br /> P -1274877-01 7P10 with Suffix: <br /> Load Date: Load Type: [ ]Whole Lj Cubic Yard [ ]fivlk I I Pound <br /> Decal # ck-up Count: <br /> Lic Stat Dot Code: RWDY elivery Count:_ <br /> SIZE MFG_ L50T# TREAD WHEEL COMMENTS <br /> 3 <br /> 4 <br /> 7 <br /> 9 <br /> 10 <br /> 11 ' <br /> 12 <br /> 13 <br /> 14 <br /> 15 ...._._ ___..._.._.. _.. _......_�,,.,._,.. , <br /> 17 <br /> 18 <br /> 000 <br /> 19 <br /> 20 <br /> Ddvers Signature: D Customer Si a f Date: <br /> Drivers Name print'40 g I Customer Name(print) <br /> I vamN that unspf ppRa rk ma,rua er r I of rNq,.,���AtK tti hter�r�flvn I (�q1 unerx pOflllb�DDrIuN ones/Dta IDWa 01 IHa 91AIA M Can(.kNU!NM IhA�nrnrmnlUn <br /> pTatlbtl nparq b IRJO arftl n a raw M mb I��y�Nl�j^mpy d ppovo to Inq On�omroel,In ntlC'dan,I am awAtO llut faMlreiallan M 11�@ hkl"MA lin Y <br /> rNWll In nw erwan,A 0/ nl mngwaf U waste lire Hauler ReplefreMan pvmuant mou t co I pOnaMoo up to 2C,GD0 par Eay,DDr�RaatlOr�n aRml�iefMl�ug peMell{�UD 10 95,000 <br /> In ate r1lDl Raoume Cott!0 Otte rna� I n cMl vanahiec up eo 526,000 por epy, par+kln0an per no MrMr�MM!�h PU0 RWw&Code do", Z,72 <br /> A2Q@2, <br /> f2aar vloaaaor a adrnln n 42%pe uD to W0.00 V Dtl Rir tl'y 4p rrinvW In IInI U: <br /> Kpxulm GDeD nOCNOn AR96Y. <br /> [ ] Imported Load [ ] Exported Load and Location Hauler Exemption Status: <br /> q Q � Address: [ ]Government <br /> [ ] LSA Exempt <br /> City state: [ j Agricultural <br /> [ ]Common Carrier <br /> Received Time Nov, 4, 2011 1 : 21PM No. 2465 <br />