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i! ^� WORK ORDER/MANIFEST <br /> Waste Tire Mauler Waste Tire Generaltor <br /> McCoy Truck Tire Sda vice,.Center,dnc. Name: �,�'_ U�.f .!�• "a� ,. '' ' <br /> 1407 Lone,10,61m=Ave. Address: <br /> hr ' <br /> Modes#d; CA 95351City: State: C U <br /> 209-521-6221 Zip: "� Phone:-:a J,� <br /> I <br /> TPID-127�.B7.7.-01 TPID with Suffix .i i <br /> Load Date: ., _j ! J. 'Load:Type: [4JVhole [ ]'Cubic Yard [ ] Ton [ ] Pound <br /> C;al # '�' `���' C1 <br /> Del [' ] Pick-up Count. — — — — — <br /> License #7,1F, <br /> I State:C 1` Dot Code: RWDY [ ] Delivery Count: - <br /> SIZE MFG. DOT.# TREAD WHEEL 'COMMENTS <br /> 1 61 <br /> 2 V <br /> 4 <br /> 5 <br /> 6 <br /> 7 <br /> 8 <br /> 9 <br /> 10 <br /> 11 <br /> 12 <br /> 13 <br /> 14 <br /> 15 <br /> 16 <br /> 17 <br /> 18 <br /> 19 <br /> 201 n r� f1 ., <br /> Drivers SignatureVL1 . <br /> Date:Customer Signature: <br /> Drivers Name (p, rft) �'-�� c: 'Rvk- kms,_ Customer Name (print) » V_FJ•� ,��,.', -k�jn��;j.� <br /> I candy that un or ponally oPpajury utuJar 111 11 <br /> 4mof it a Slata of calllorrda that Iib amwU)n I C:d'111y tlwl Under puna ty al punury undar 1nG WW6 vl IhG Fhala W Culllot Ju Ibul Wa Inlamudon <br /> provkled Wove Is Iruu and oorreot.In uddalon,I om uwaru[nut 14LAIlaution of IN!.Informallon umy providud ubovo 4.ow a11d Conw.In uddidan,I tion uwuru that IWulllaution at thio Imornmllon may <br /> r'eaull In srepunuion,ruvoaatwrt,or donlal of rbnoval of 1141 Woo)Tiro Hoalor RdWaln%ion purt=nl roAUU In Civil lmwitiuc up Iti sde,000 pur day,put vlolatlnn or oominWrOve puliuldue Up to 31,000 <br /> Lo <br /> Puafic Ro wumo Coon o6all6n 4NdO and Tray reault 4i civil putuWwE Up to 0.rd.Ut1P por day,yae pm viutdliun pur day as daccrload In PUI)IIC 19a60urou Cudu auufit n d2uli2 <br /> violation or adnllnlatrallve peruiluo:up to 65,P00 por vlolitaori-por Cay as doocrlbod Al FUUIIC <br /> Rauourca Cod.suction 421fi2, <br /> G DrtQ [ ] Imported Load [ ] Exported Load and Location Hauler Exemption Status: <br /> Tr Address: [ ] Government <br /> m �M [ ILEA Exempt <br /> w `�° Ciiy: State: ( 1 Agricultural <br />