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4 <br /> NOV-06-2004 21:22 From:UTILITY TRAILER SALE 209 444 8823 To`-194688392 P.3/3 <br /> 08/04/2008 08: 11 FAX 20957` Mk;COYTRUCK&TIRE Rf)003/003 <br /> WORK ORDER/MANIFEBT <br /> 1274877- 16 382 <br /> 0 <br /> Waste Tire Hauler Waste Tire Generator <br /> McCoy Truck Tite Service Center, Inc. Name; �J 'T,L 17Yl-AA LA(Z-, <br /> 1407 Long Palm Ave. Address: -2(_Z'� 'i - 1�4,r)er, <br /> Modesto, GA 953511 �1 City: �h�,_� x State: <br /> 209.521-8221 Zip; t _d Phone: 42d_.A� Lj <br /> TFID-1274877-01 ITFIDwAhSuffix (7 <br /> Load Date,$ l.* 01 Load T pe: Whole UGubicYard Ton Pound <br /> Decal # V 7 - a l I ol �t_ M Pick-up Count: - <br /> License 0.1 S% `5Q I S, o,C--N cot Code: RWDY [ ] Delivery Count: <br /> SIZEMFG. DOT 4 TREAD WHEEL COMMENTS <br /> 1 �o�� � _MJ1C1� 1�,�c I <br /> y __w...-- <br /> 2 1-3a� t <br /> 3 t907 <br /> 9 <br /> 10 <br /> 11 <br /> 12 - <br /> 13 <br /> 14 <br /> 15 <br /> 16 <br /> 17 <br /> 18 <br /> 14 <br /> 20 <br /> Drivers Signature; Customer Signature: Date'/ L <br /> Drivers Name (pr �Z, rg1,� Customer Name (print) <br /> 5,•r7 Ural unrla,PP110Y or p try un ar I h.—o the azoic of Calllornlo Mol rhQ 111011.1111 'tf112Cen I ce ► Lncer pamliv d 0-61Y InA,Ilia Iawa of WS Stale d Colifo'no Pill 110"`V„PPtOn <br /> p'eoldnd <br /> rapGIhM�ro i,hue and carrel In addnon ht.-1—Yr/IM 161aliCal011)l Hlia IP'oa1`at1OP OInY n1r+,h1a,1 ahpva la,n.P and oorrca.In addnM.I dm aworo Q1,3I lalafipehm pf this inlorrpalyn nnay <br /> lllt In YOCAAIon,tavoCarlon,z tenial of raneml et rhe 1ValR I ire Mauler of WeltonJuM1111 460�„Lv-II oanallles VD 19 S25,000)or Qay pe,VluAdlnh m armnlaDPd+a ponakiaa up To98,0110 <br /> to pu6hc tlaaourtn frwfa ePr-tan 42080 and may r9aull fi CIM!panMYe�uC IO;P5 000 per rMR pP' par rIQIaJYr�pili J•y a dovlood h PuhYo FaseurQa Ccl]0:7Dupn/C96Q. <br /> rbahor or cdnirlstralNa u.r+P4lrs uc tv 25 0,00 par ndahon pe (Jay as dsacllAnJ l i AlnGr. <br /> RAW,"Coda—Im 670117 <br /> [ ) imported Lpad ] Exported Load and I-noation Hauler Exomption Status: <br /> �Q '�atcr Address: [ ] Government <br /> ' [ ]LEA Exempt <br /> w ti Cily: State: <br /> ( ]AgrlCUltural <br /> �'" f 1 Commcn Carrier <br />