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NOO-06-2004 21:22 From:UTILITI' T"'AILER SALE 209 444 8823 Tr—,94688392 P.2/3 <br /> 08/04/2008 08: 11 FAX 20952 MCCOYTRiir..K&TIRE 002/003 <br /> J `f WORK ORDER/MANIFEST <br /> ,.. � 1274877- 21844 <br /> Waste Tire Harrier_ Waste Tire Generator <br /> McCoy Trick The Service Center; Inc- Nam.,: J -r i Li ` Y h�� ,��V)) <br /> 1407 Lone Pulrn Ave. �1 Address, ! �"4 Q 3 Oar j_)j' <br /> Modesto,CA 95351 (� r1 ` City: t I►rc/a state: a'"t I <br /> 208521-6221 r1� zip.. 9$�+�5-0 Phnne; <br /> TPID-1074877.01 TPID with Suffix <br /> Load Date '13Load Type: whole Cubic Yard Tar, Pound <br /> Decal # © Pick-up Count; <br /> Llc;enee #: '7 J9770�✓ State:'�v Dot Code: RWDY [ ] DelivC Count: - <br /> SIZE MFO, DOT tr TREAD WHEEL COMMENTS <br /> 1 L1T71 p6 1 Cg3s ! -- <br /> 2 -S-17`00 0906 C 5- <br /> 77 q5 <br /> a <br /> 9 <br /> 10 <br /> 1i <br /> 12 <br /> 13 <br /> 14 ` <br /> 15 <br /> 1R <br /> 17 <br /> 18 <br /> 19 <br /> 24 <br /> Drivers SigrlaluA'e: Q., bate: -J - Customer Signaturw: Det /3-d <br /> Drivers Name (pri J 1 Customer Name (print) <br /> -1 MR;1 et under eenplty 01 597m,under one tawa 0r tna stun o 'arlbI CfM111,'InYI—0-p,-I y of­j.V u,*,the bur d TA.,jta#01 GV1101,161 lhpl the Mb,—tlar <br /> provided <br /> ave Id irui NMI uireacl In adai-n I ail—arm dvt we11 mond ur t-Pe�nrannatlan may p-1-d ebwe a vue onn—o.In eeoitiv,1!Im s—re In.1 lkwlaatlah nr ihle:n brmelll t�11ey <br /> �bfull M Au Ap AfN1011,;MCerlep,01 ppnlnl Of mnal-ai ar Ula waele rife Hpule•rieplSVvdon OWMUMN rpavb In orA1 pmahlo-uC to 6zt,Vvv c:r db,.aor violelhn or 1dm!n1e1,90vA 04...1161,tl�0 55900 <br /> 10 PVVC 4IA71rrq Coda aa_nan amp and may r6AJll.r d,11 pen6lrle5 u0 to$25,000 per Q5y,6,M1 par vialetlm pm te}a;deScdDAe in rubk iRco0uf0e Code AecilOn 149(2. <br /> V101e110,er IWAIA1611A1 4 61�91UAA up In s5,000 roar vivim1M per ney of dagcrlbee fn Pubtic <br /> r1AACur.a c»soctlon 6FFF?. <br /> I ] Imported Load [ ] Exported Load and Location Mauler Exemption Statl.l5: <br /> �e�G�Qt¢Ar Address ] Caverrment <br /> m [ ] LEA Exempt <br /> w Gley: State' ]AgrioUhural <br /> [ ] Common Carrier <br />