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JUL-06-2009 11:50 From:UTILITY 'AILER SALE 209 444 8823 To;-994688392 P.2/2 <br /> 07/06/2009 11 :47 FAX 20952 11 MCCOVTRUCK&TIRE IR 002/002 <br /> WORK ORDER/MANIFEST <br /> Luft 1274877- 18875 <br /> a <br /> Waste Tire Hauler Waste Tire Generator <br /> McCoy Truck Tire Scrvice Center, Inc. Name: U-P7. Lj-r� T41 L 6-(4 <br /> 1407 Lone Palm Ave, � AddrpSR: j z L p � 5 ` �q�ti�� �L-b <br /> Modesto. CA 95351 l�City. A State. C-A <br /> 209-521-6221 � Zip: G�S S'3�-r'D Phone: a.C7q 44Li <br /> t;l b <br /> TPID•1274877-01 TPIQ With Suffix 4 47) L Lt,$ S <br /> Load bate: 0% Load Type: Whole [ ] Cubic Yard Ton Pound <br /> Decal # Pick-up Count: - <br /> License IState:C Dot Code: RWDY ] Delivery Count— <br /> _ SIZE MFG. DOT# TREAD _ WHEEL COMMENTS <br /> 1 a y - Z41151 Quit/ <br /> 3 <br /> 4 <br /> 5 <br /> 6 <br /> 7 <br /> 8 <br /> 9 <br /> 10 <br /> 11 <br /> 12 <br /> 13 <br /> 14 <br /> 15 <br /> 16 <br /> 17 <br /> 18 <br /> 19 <br /> 20 <br /> Drivers Signature: Gate: 0 Customer Signature: Date; <br /> Drivers Namo ("4)- <br /> TOT7,(—NtA�— Cusiomer Name (print) <br /> 1 mnl!y Thar under mwty c600rjury unaar me I1w6 w no YIAIa of CjOornla chac rhe hlormallon I ce"y nor unuvr pgnbhy 01 pl;dury urhler rhv lawn o 9m VIM,of Caldovaa rtm1 jw ur wnwhun <br /> OMMOC MOVO C Into and oorrom.Ir addition.I am awara Thar mlylnngllnn pl mir ddWmpUa;I may pfovmad abovC N vWl irld WIWI.la addaloa,I am aware That Ulalllamlah OI Tloa Inforwaom may <br /> 165UI110 au911ar101u4 r 60 g1nn.nr Mnlpl nI r$ne%al of I"INUP TOA rrau16r Hpry.fha[roe A04,4m �'a!Y'7 In'710 ppnpUBB up To 924.004 pay Gay.par vlplarypn or gWnlnlg[roii�pjAAiT40 up in 55,400 <br /> ro Public RaaOVICE Cado SOCIIOn dXWI)Ilk May rawlh In orvtl panahlas up w%2L'000 per day,per pnr Taahlear•Dar day as deacrlbed in Public Heaavr(q Coda moon 429@. <br /> 4101611011 01 A0MIhl0IfM1wv pphpplM up 10$5,000 p5r wolpilpn por Ay AF aa90rlbo h rIM110 <br /> Reeource Code aecllon 41M. <br /> ( I Imported Load l ] Exported Load and Localiaii Flamer Exemption Status: <br /> o�`D�t4�' Address: <br /> � ( )Government <br /> m. k ( )LEA Exempt <br /> w f City: State: [ ] Aodoultural <br /> N Ti <br /> [ ] Common Carrier <br />