Laserfiche WebLink
3582875 /4 Pick Up De!i ery a E", - 1 <br /> Mauler Tire Program ID / Site Suffix IInI IIIf�J! Facility'Telephone Number <br /> DATE Td r �u.l Hm _ole 7In-Lbs. @RUE <br /> � Ire Count �Weight <br /> 13 Volume Cubic Yds.❑Weight In Tons <br /> ` 1 <br /> aulur Nan <br /> AA, t <br /> ox <br /> klsiller rglrpl7Ulye Ntr.lttlier L �/ ,��4.. <br /> � r'ICiC:�P'E...�:i ,3111 f.as I*.11lie{' <br /> Wh016 Tit 1 CERTIFY THAT UNDER RIALTY OF PERJURY OF THE <br /> (N 1LAWS OF THIS STATE OF CALIFURNIA THAT THd <br /> 1�•+ Tire*) IH <br /> PQ OVIo ROVE 46 T T. 177' <br /> ORRC <br /> - y <br /> Padilla Tire Disposal Date: <br /> P.O. Box 1035, Linden, CA 95236 1( <br /> (209)405-5675 <br /> I <br /> Customer:') f #r.•....� i` a.'I�,. <br /> t � <br /> Count Description Price Amount <br /> Manifest# <br /> r� Passenger Tires $ '.:Ir'... <br /> � $ ••, �� .,� .�... Trip Log# <br /> Light Truck Tires $ $ <br /> License# <br /> Truck Tires $ $ <br /> Misc. Tires $ $ ..� <br /> Wheels $ <br /> $ Payment Information <br /> Trailer Placement $ $ Cash $ <br /> Trailer Switch $ $ Check $ <br /> Trailer Removal $ <br /> $ Charge $ <br /> Total Due L; .... Total Recelvod is <br /> Driver (, <br /> t diff (1 � Customer. 1 , <br /> Signature: , <br /> • � '�J• .�f Signature: `x,-<.,_,.• •; l. .. �- ;.;, ,_. <br /> 900in TFd CO:TT 8009/LO/OT <br />