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FORWARD ATE TICKET GRID <br /> INCORPORATED <br /> 9999 South Austin Road/WEIGHING LOCATION P.O. Box 6336 WEIGHMASTER <br /> anteca, CA 95336 Stockton, CA 95206 i_T E <br /> :ndfi)): (209) 982-4298/WEIGHING LOCATION Main Office: (209) 466-4482 �r'--- DATE IN _ TIME IN <br /> 'resource Recovery: (209) 982-4936 Fax: (209) 465-0631 <br /> 1 5. _ <br /> 7211 i DATE OUT TIME OUT <br /> �:::EV IN Ml k."L E-BE!-.,; �— _ VEnICLi= ROLL OFF <br /> l4 i L_-�11•, tht,t.: .-.._,«:-;�•c <br /> TO ,, :'Tr ,:c „c - REFERENCE ORIGIN <br /> T <br /> 6 31 1 1 �': 's. S A S Pa L' F:O R`Y <br /> Manl_!ai Tare Weirpht 1 ?EC) L-rq <br /> le o t W q i:c F-:t _; }41-;,': . ; <br /> CITY. UNIT DESCRIPTION RATE EXTENSION TAX TOTAL <br /> _2.c_riT,--jN ; _�',;er -1=-s II Tc�n ! I <br /> j <br /> i <br /> I <br /> TEIGHMASTER CERTIFICATE THIS IS TO CERTIFY That the follow.,),o2scnoE __ „ _ Signature is <br /> s�:erdcc,e.wi c is a recognized octhenty of accuracy.as c,esc•aec ;no <br /> c+essions Code ocministered by the Division of Measurer^ent Sto,)ocras of fne Ca forrno DeG;r <br /> NET AMOUNT <br /> ni # <br /> fesy± 61 '416 <br /> P•tJ• # NONE j TENDERED <br /> T'il '. ei- f �. r4 • 5--'.O <br /> `_'=hedU1e E4 ::7 owe s --n advan_a :Ji,, ec"-lv wit_; the CHANGE <br /> .i982-4C"9 ti- =—hedUIe <br /> Drive `;afe1y <br /> CHECK NO. <br /> Wa-y-led paper <br /> DRIVER'S SIGNATURE <br />