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p r <br /> `I. i O `W 1 SITE <br /> Jaz INCORPORATED <br /> " a.a a-��� � SCALE.:OpEFiATOFi!c =. t ' <br /> 9999 South Austin Road/wEIG"ING LOCATION 1145 W. Charter Way 9Cf ,Y, I'"li k.i I._� <br /> Manteca,CA 95336 Stockton, CA 95206 <br /> Landfill: (209) 982-4298/wEIGHING LOCATION Main Office: (209) 466-4482 ',4 DAT <br /> +'s06 ; �' Fax:(209) 466-1067 r.•. i.?.:+1"I ,+,Y'+t ....t ,. . L� ,.tr./ ,.+.i Y <br /> 'DA'TE OUT 5 i ;x p:,;TIR+IE b117 <br /> J. .I1.l<hf' <br /> ..C) I.t:7 MX. � VEHICLI's' � . ;��'Pi '& �ROLL'PEF <br /> ACTON,, 1::f`4 t�"'i.�[7'..'.'i l�. 'ti •,?: i <br /> 2064'71%7,79 <br /> A <br /> 00- :1.L' <br /> '300 00 ':I.I::. r:'::I„6,T; TN <br /> f <br /> ;RATE nF` t"%, 05XTENSIC N.'U ,TOTAL``afi' <br /> :I.„00 UP <br /> L.00 1''T' I:IJI:::I.., <br /> I`'#:'ii'�:I:I��I:i;::'r'T'�� :'.:;,e,,c'I,(;,,r;�:•'. <br /> NET,'AMOUNT .. <br /> ; TENDERED kTO <br /> CHEGK NO:%r, <br /> DRIVERS SIGNATURE - <br />