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09/21/2012 13:17 2099319183 SHOP N BUY MKT PAGE 04 <br /> I <br /> :4 <br /> I <br /> Trik <br /> i Manufacturing, Inc. � Work Order <br /> Tire Recycling Division j <br /> 512 Harbor Blvd Scheduled ... Work Order No. <br /> West Sacramento, CA 95691 5itarzolz 23406 <br /> Ph: (916) 371-1700 Fx: (916) 371-8161 <br /> I <br /> Bill to Service Address <br /> N Auto Repair N Auto Repair <br /> 3403 East Main St Suite B 3403 East Main St Suite B <br /> Stockton,CA 95205 Stockton,CA 95205 <br /> I <br /> I <br /> PO# Contact Customer custo er TPID# Driver Terms <br /> 209-463-8881 130514-01 DW Due on receipt <br /> Description qty Cost Amount <br /> anifest: j <br /> Comprehensive Trip <br /> I 0.75 <br /> Log Number Load Information Facility - Program <br /> 4462392 -- A Pick up FOeeryM �TE M <br /> Hauler Tire Program ID / Site Suffix D;' ` r. Facility Telephone Number <br /> C <br /> 1480835-01 eTuwcourtt ❑,, hClrtL;bs;, <br /> �' �-►- IR <br /> Volume,Cubic,yda-[Jht in Tons% 6 <br /> Hauler NameS- <br /> v - a <br /> aa,lcr Telephone Number Address Same as Haul,'r•G _I <br /> l.,fnr. I CERnFY THAT UNDER PENALTY OF PMURY Of THE <br /> `�I 1 QI&,'nCQ9J LAWS OF THE STATE OF CALIFORNIA TH TNFf • P <br /> -• ,' ` INFORMATION PROVIDED A80YE.Ii TRVC C [I, �/ <br /> i'GrRC•,t. x <br /> A finance charge of 1.5%will be charged on pest dup accounts.Annual rate is 180 .Last <br /> m nth charges must be paid by the 10th of the follo\ing month.All pick up rcque ted will Total I . <br /> have a$50.00 minimum charge whether tires were p eked up or not. By signning tl iis work <br /> order you acknowledge that service has been provid d to your companyby Tri-C ire <br /> Recycling Division. <br /> Hauler TPID# <br /> 1480835-01 Signature <br /> %a <br /> flii-C Manuzactunng,Inc. Work Order M <br />