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Nov 05 08 01 : 46p p. 7 <br /> Lri �.�ffiFrfrfiEil� 1 Jia L r~i SCIti>rl�: <br /> ba <br /> INSTRUCTIONS 3N BACK OF PART 2 Dv NOT TAPE. S'.4F�E dE Jl•cL:L�'" —121 . 6-L <br /> 'YefMcle Infartttatfos .• - = - -- 7-77 <br /> ry <br /> —— <br /> ' - 11 ElRE R, <br /> ti <br /> - �0. �-�- 7� <br /> Driver's Name(print) -driver's Signature Dal E' <br /> Comprehensive . . Number Load Information FacilityProgram • <br /> 3234310 -- C ' Pick Up Delivery i III <br /> Iii, LJ 1t� LL--i <br /> C HZVJJE-Tire Progrorr, ID Site Suffix `j^I Er <br /> �^j Facility Telephone NumberDATE o F <br /> t1l � r 7 r-7i ; ! ' � <br /> Ylhele Ti-e Count C Weight'r _bs. <br /> a✓ <br /> 4oi :m_Cubic Yds.C Weioh•,it Tor._ <br /> 0 <br /> Whoic Tres. _F r:� TrE 5•�'= cn_FC <br /> .t:14nf:.:i,Jl•;'F•.: - =;<�R'_G Ah.Compreh <br /> ensive • Log Number • • InformationProgramire1 Site <br /> Suffix <br /> 323431 -- B d pick Up " Delivery I <br /> Ha,,le. Tire Program: i7 Site S,:fflx ?� 0I— I 1-C <br /> rp�rliiy I. .C} •.� .c •ilmbEi <br /> DATE `--i rte' I ( I f _ pp—• --I r <br /> r w l_J v.r:oie Tire Cc:�t W;:qh 'r ..0 1- �. i � N OZ <br /> _' i Y 1 Z f —�' S ~ Clr' ai•.:.--:e e.ibic ":is.❑�1•cight',r,Tons r4-'e �- /^4 ✓�zr� <br /> 7>o V 2 Stj niL.'C. '^f n <br /> u•rarr;,::.Jr.a- -- i.af n.r0�:d:eC['. <br /> Comprehensive • • . Number* Load Information <br /> (� Program t♦ r <br /> e Suffix <br /> 323431 0 -- A Pick t_'� U Delivery n I I ; i �' I <br /> LJ L V i_J U LJ i� <br /> T'.re Prow,irn tD S-.e Suffixl F-1 Facility Telephone Number <br /> v DATE i ti `l ?i t--tIu r7 F-1 1-1 <br /> L <br /> u: L1 Whole TirE Count O Weigh;in Lbs. � '—• <br /> OIJr12 Ctrbic Yds. Weight ir.Tans -. y •- <br /> f <br /> Vk r�1S A0 D __j <br /> F,F <br /> 1,)C1. --Z) 6 o i�: C <br /> � �� r <br />