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i <br /> LQ <br /> JI �. <br /> APR 2 2 2004 <br /> -i VII 'INMENT HEALTH <br /> '/SERVICES <br /> f�0j� FORWARD <br /> SIT <br /> E TICKET GRID <br /> INCORPORATED w? ' <br /> EIGHMASTER <br /> 3999 South Austin Road/WEIGHING LOCATION P.O. Box 6336 <br /> Manteca,CA 95336 Stockton, CA 95206 t <br /> Landfill: (209) 982-4298/WEIGHING LOCATION Main Office: (209)466-4482 DATE IN TIME IN <br /> Resource Recovery: (209) 982-4936 Fax:(209) 465-0631 ' ' ;,`. - 1 <br /> DATE OUT TIME OUT <br /> 7i..T T i.'V TFa F.'i 7--lP F' i <br /> STT717 -rREEN VEHICLE ROLL OFF <br /> VPRY4r.T TC (I.A qr.^,f o. REFERENCE ORIGIN <br /> 4392 PP V}:r niv'-x I,T.', <br /> 0 siGn^^ T irjl;t. t}^ ,`40 . 0 LE T_Ytt . !md - SCALE TTCF:FT <br /> - :'ii . 00 LB <br /> CSP) LrR 7 . E7 TN <br /> QTY. UNIT DESCRIPTION RATE EXTENSION TAX TOTAL <br /> TJR 1 7 ^7 k s Ti . r�T7. <br /> riFr,^,Rr mn,t: S <br /> WEIGHMASTER CERTIFICATE THIS IS TO CERTIFY That the following described commodity was weighed,measured,or counted by a welghmastec whose signature E <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 AMOUNN` <br /> TENDERED <br /> MANTFE,STFB387 <br /> CHANGE <br /> CHECK.NO. <br /> DRIVER'S SIGNATURE <br />