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--— — PAGE e7/14 <br /> 11/03/2011 13:02 209-5g;%4Ccoy <br /> TRUCK TIRE <br /> � WORK ORDER I MANIFEST <br /> 4 1274577- 3727.1. <br /> MCCoy Truck Tire Servic@ Center,Inc. Name: <br /> 1407 Lone Palm Ave, <br /> Address: s. <br /> Modesto,CA 85351 City: State: <br /> / <br /> 209 Zip: Phone: <br /> -521.8221 <br /> PID-1274877.01 TPID with SU X: <br /> Load Date: Lead Type: Whole [ ]Cubic Yard Ton r ]Pound <br /> Decal # - Pick-uP Count: <br /> Ucena �j s �; Dot code: R Y ]Delive Count_ <br /> 'SIZE MFG. D # _„ __- TREAD H COMMENTS <br /> 4 <br /> 5 -- _- - ...... <br /> 7 _... - .. <br /> 12 <br /> 13 - - ---..._. _.__,....._......., .. . <br /> 14 <br /> 16 <br /> 17 <br /> 18 - .....�_.._.... ----.._._ ---..._... -,._.,,,...._.... .. <br /> — <br /> 20 <br /> (. C/ <br /> briv®ral Signature: � Gustomor Signature: Date: <br /> Drivers Name Customor Name(print) <br /> WV <br /> I oo111N lhey undor poflally UrIEOI Isle' Trop pp((CaM1ttrrn4a�q1 e mfamatkn 1 cc�tl((yY_Mtat under ponally d ovAury o I�ws ei kho lato of CetllPorrtle emt it1D InfpnnMlen <br /> p pylCed above r.IMt!end tie rmt 1rL.'= om nvrarO telnMlaoUon of ttlla kAermaeon nary prey det ahvue I.wo afM wlect In eddkbn I m�t�ra+v thm fi�Mkam�of m Mel <br /> 39. mny <br /> aaun In xe prr ata,mvocaeea.er ocmlet of rr+na srl oa the Wnnla Tire Houlee rtop1a1m11m p rmunnl —1t erA p rinflI +utt 1E>f=101.11 L1y p01 vlalaton ar ntlFnhlatruovn pmnn tM+uo m 90.fHM <br /> to the PUWIt:RM.11 Qode eeMlon A%W ins rnq mall In ttNll p namoA u h�,75•om prr tley, par.noiallon par nay a�ne�mlwn�n wni ti f>•rren conn�arJtnn e <br /> per ADFXIOM or*dMh4Wr d..epe nelllee w to$5.D06 pef`bl�lyn <br /> P. OPy 9P flirri7e0 M F uDlle <br /> YlneourrYl GDCa pnceon n24CS, <br /> ( ] Imported Load [ )Exported Load and Location Hauler Exemption Statue: <br /> Address: [ ]Govemment <br /> [ J LEA Exempt <br /> 49 <br /> a City State: ( I Agricultural <br /> [ ]Common Carrier <br /> Received Time Nov, 4, 2011 1 : 21PM No- 2465 <br />