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———————————— <br /> � � FORWDSITE TICKET Va INCORPORATED GRID <br /> 9999 South Austin Road/WEIGHING LOCATION P.O. Box 6336 WEIGHMA ER <br /> Manteca, CA 95336 Stockton,CA 95206Landfill:(209) 982-4298/WEIGHING LOCATION Main Office: (209) 466-4482 DATE INResource Recovery:(209) 982-4936 Fax:(209) 465-0631t <br /> TIME IN <br /> DATE OUT ME <br /> TI OUT <br /> k <br /> VEHICLE LL <br /> F;3 6Q.;% -g- =FRIOLL OFFF— <br /> REFERENCE LI— ORIGIN <br /> Gro3s We i <br /> 5j-o.Clt) <br /> We lont <br /> 18, 106- L5 05 TH 67- AAL� <br /> CITY. UNIT DESCRIPTION RATE EXTENSION TAX TOTAL <br /> "-'L t2i E'� J. Ci'l t, <br /> WEIGHMASTER CERTIFICATE THIS IS TO CERTIFY That the following described commodity was weighed,measured,or counted by a weighmaster,whose signature is <br /> on this certificate,who is a recognized authority of accuracy,as prescribed by Chapter 7(commencing with Section 12700)of Division 5 of the California Business <br /> and Professions Code,administered by the Division of Measurement Standards of the California Department of Food and Agriculture. <br /> NET AMOUNT <br /> TENDERED <br /> 14•II F E 7 <br /> CHANGE <br /> CHECK NO. <br /> DRIVER'S SIGNATURE <br />