Laserfiche WebLink
WORK ORDER/MANIFEST <br /> 1274877- <br /> Waste Tire Hauler Waste Tire Generator <br /> McCoy Truck Tire Service Center,Inc. Name: <br /> 1407 Lone Palm Ave. Address: <br /> Modesto,CA 95351 City: State: <br /> 209-521-5221 Zip: Phone: <br /> TPID-1274877-01 TPID with Suffix: <br /> Load Date: Load Type: [ ]Whole [ ]Cubic Yard ( ]Ton ( ] Pound <br /> Decal # —_- _ [ ]Pick-up Count: <br /> License#: State: Dot Code: RWDY [ ]Delivery Count:___ <br /> SIZE _ MFG. DOT# TREAD WHEELCO?AIv117 <br /> TS <br /> 1 <br /> 2 <br /> 3 - <br /> 4 <br /> s _ <br /> 7 <br /> 8 <br /> 10 <br /> t1 <br /> 12 <br /> 13 <br /> 14 ~` <br /> 15 <br /> 16 <br /> 17 <br /> 18 <br /> 19 <br /> 20 -- _� <br /> Drivers Signature: Date: Customer Signature: Date: <br /> M. <br /> Drivers game(print) Customer Name(print) <br /> I conify thal viJer panaiy of perjury under the hags of:he Stale of Caofo•nm Fiat fhe Informallon IcMlly that under penally of penury umiar the IoM;U he Stafa of Calllhma lhet to a dormat$Qn <br /> PMAtted aha w IS We and oonnd.h addllbn,t am 9y ere Tat ig Wirahon o1 INa Infor Iaton may provided above is ttun and conetX In a WIlion.I am awes tl'Wt raleiFtaam of the Inbmralion n v <br /> reaull in euap-nsion.retacatlon.or denial of renmwal of the WBBle Tire Hooter R"fration pursuant mond troll panahlee to 10 S29 Iltdl Wp�Yy pet oblation a aOnI' al'"pennIli&%MI.£5.080 <br /> W!ha Ri bllo Re .tae Cade as:spn 4?0B8 Bnd t ,r r-.1t in evil par+rw,up to 525,030 par day. per Minh=P.day as dedcn�0ed I=7-Rasotrca CAtle ee�c`t 42:U2. <br /> per violation <br /> l:es <br /> or aarnhislWive pertaup to$5.000 per vialation per day as daw"nrd it PuNic <br /> Resouros CMe section 42962. <br /> �Ole vah Ar [ ]Imported Load [ J Exported Load and Location Hauler Exemption Status: <br /> s �o^ Address: [ ]Government <br /> [ ]LEA Exempt <br /> City State: [ ]Agricultural <br /> [ ]Common Carrier <br /> 1 <br />