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11/01/2013 11:40 209982(''179 CUTTER LBR PAGE 02 <br /> 12748,77- 0 ' <br /> Waste Tire Gener®tor. <br /> McCoy'RuckTire Service Center, Inc. Name: 1� t;1 [ �1d�.�� ' �� <br /> 1407 Lon eefm AVe, Addrses: t ;. <br /> Modesto.`ICA 93351 Cll �t L t��.i ., 5tsteL&Al <br /> 208.521.5221., Zips Pnone:'��:t . _ �,:q,.•c.�. �' . <br /> TPID-1274877-01 TPID with Suffix: <br /> Load Date., i .�- -[. 1 ~. LoadTVD011 Whole [ Cubic Yard I I Ton—LI Pound <br /> Decal# -- ,,;_: Pick-up count <br /> LIcenea# 1c �' i'' Stater rr.r. bot Cod®; RW.DY [ Delivery count;: <br /> .�.,...— <br /> REGULAR TIME' [ ] OVE CUSTOMER PO# <br /> FLAT REPAIRS t WHEELSWiTCFiES �^ M7IDISMT�,O—_ <br /> LIMSE NO. " r 7. .') NICLE MAKS -nAILFAGE•�l VEHI ENO <br /> LOCATION: P"r <br /> WORK PERFORMER. MILE <br /> CAGE IN <br /> IF.1;.AGE OUT <br /> 79 <br /> 7 AL <br /> 4 t t�• I I'� ,, ; 1 ''.,tl..ir. '-y.. '� .. fi.r i r'.' '1 S/N p t <br /> L <br /> � ';tea.1'- ".� `:�',r.Ic''�`�,-�`--`r-��r�—•a•� i y r /�1 4 '(�1. L:�.• .:.. <br /> (y TIME IN <br /> or TIME OUT. [ .vt <br /> SIZE moa To, TREAD WHEEL COjN�NTS - <br /> t � J. <br /> 4. <br /> Drivers SI natu � ;' .1. <br /> orivera Name rint r ,Cu8t0 er Name(Print) <br /> 10"ry III ssM old Of pp�prr��v�yy undiK tl,s Isw la tiro ItpettnDUon I oe tltr�UMor pw,gAy d PSI VN INr110(M of tl1W Cro I 011 <br /> p oboes la true ad eoirdttln NOtllfltlf6 I air asearo tttar AWA en�I Infondia,roay ot>aw le WO and m,vdL n 1 mOt fg'wCdw of It <br /> inl,awv� q <br /> Iw�I( 0 sten:Isyppllolt,tY tl� I r#MMIiI OI CW W1�TY'a n Pur"M =L11 tliA!p�nMlbe up per�yporv�ofi Ic on air odnUllMlir��1�pen.I�uD W 16.000' <br /> t0 blip MCoya GCOa 3000M 4POf10 ZI MMy n�I IM lIW poiWllaa vA m �00�1r 4dY. per MQw11J prr dw Mia a kl Putl�R�souroe eoea Mlstlan+71ua2, 1 <br /> por wmruai w eamr>le penuWoo,+p to Ce.000 psr1�riolRfrfn par day as d�sFJlOdtl mPuhlb . <br /> rtaawmr f�4e Mo00n 4�, ' <br /> [ ]IrdIpoited Load.,[ ]Exported Lead and Location Hoular Exgmpiion states; <br /> e!� Addi8158: [ I Govemrnent <br /> • ,� .' ', [ ],LF1ti Exempt <br /> State: (, ]Agriouliural <br /> ,Received TimWeN o 1. '201+3 11 ; 3'4'AM`��No, 0868 <br /> Common Carrier <br />