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--_------- -'-----_-_-`' _--' ' -_-_- <br /> - - ' <br /> WORK ORDER I MANIFEST <br /> 1274877- U 3 , <br /> mcCoy Truck Tire Service Center. li1c. Name: L- <br /> 1407 Lone Palm Ave. <br /> Modesto,CA'953511 CITY: bp":� State: <br /> 209-521-6221 Zjp:,� Phone: <br /> Load Date; Load Type: NJ Whole Cubic Yard Ton Pound <br /> RWDY [ ]Delivery Count:_ <br /> Dot Code: <br /> License Sta e: <br /> SIZE MFG. DOT# TREAD WHEEL COMMENTS <br /> 12 <br /> 14 <br /> 17 <br /> ' <br /> Drivers Dat4 Customer Signature, <br /> [Drivers Name(print) 7zi*: '�,",!,.- Customer Name (print) <br /> tion Status: <br /> i | Imported Load Exported Load and Location Hauler . <br /> Addresc [ ] Government <br /> [ <br /> LEA Exempt <br /> P � city Agricultural <br /> ] CnmnnmCanier | <br /> | | . <br />