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TRACY-DELTA DISK— L SERVICE GO. <br /> P.O. Box 274 <br /> TRACY, `CALIFORNIA 95378 <br /> Phone-(209) 835-0601 <br /> INVOICE <br /> Customers J <br /> Order No. Date — - ' <br /> Name <br /> j <br /> Address <br /> DESCRIPTION <br /> ROLL-OFF BOX <br /> COMPACTOR RECEIVER <br /> i <br /> MISC. <br /> i <br /> i <br /> KEEP THIS SLIP FOR REFERENCE <br /> erj Rec'd By <br /> Q 3 2 <br /> 31594 __ 121-Pick Up F-1 Delivery ❑ ❑ ❑ ❑ ❑ a a-o 0 <br /> °' Hauler Tire Program ID 1 Site Suffix Facility Telephone Number <br /> � DATE <br /> = wa ❑Whole Tire Count ❑Weight in Lbs. <br /> y I1111� ' V Y V lume Cubic Yds. ❑Weight in Tons 4' eSS <br /> E :..3 State � <br /> O .Puler Nc^sP9 r <br /> � !mak� �is oSc � Duo � � � )-� � <br /> Haulerelephone n' 4rrtl)@C Q 9 F] Address Sar as Hauler Initials <br /> I CERTIFY THAT UNDER PENALTY OF PERJURY OF THE <br /> Owl <br /> � (N LAWS THE STATE OF CALIFORNIA THAT THE <br /> G Y <br /> �./•n/ �(/[ J Whole <br /> Tires) INFORMATION <br /> TION PROVIDED ABOVE IS TRUE AND CORRECT. <br />