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FORWARD SITE TICKET GRID <br /> INCORPORATED <br /> 999$South AuStrn Road/WtIGHING LOCATION P O Box 6336 WEIGHMASTER <br /> ca, CA 95336 Stockton, CA 95206 <br /> affI (209) 982-4298/WEIGHING LOCATION Main Office (209) 466-4482 DATE IN TIME IN <br /> ce Recovery (209) 982-4936 Fax (209) 465-0631 1,' ,. ,� I', t s ' ,� 1� <br /> tr f <br /> V` ' [�\ DATE OUT TIME OUT <br /> \ <br /> Qp / VENICE! ROLL OFF <br /> i s7 —eri� I3 —i Y- 'l L ( r - w ,-, - <br /> " REFERENCE t ORIGIN <br /> t .YHa 2 <br /> =' i+ <br /> 3til F i r — !.`"�1� r? i s�r�m r 11 r � t � r•t,� <br /> QTY UNIT DESCRIPTION RATE EXTENSION TAX TOTAL <br /> P r <br /> WEIGHMASTER CERTIFICATE THIS IS TO CERTIFY That the following described commodity was weighed measured or counted by a weighmoster whose signature is <br /> Dn this certificate who is-a recognized authority of accuracy as prescribed by Chapter 7(commencing with Section 127DO)of Droisfon 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 AMOUNT <br /> y {� TENDERED <br /> v 1�RtP�.. 4y�7 rd � y ...V L•dT t r <br /> CHANGE <br /> CHECK NO <br /> DRIVER'S SIGNATURE <br /> • <br />