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FORWARD SIT <br /> INCORPORATED E TICKET GRID <br /> 9999 South Austrn Road/WEIGHING LOCATION P O Box 6336 WEIGHMASTER <br /> V' CA 95336 Stockton, CA 95206 <br /> (209) 982-4298/WEIGHING LOCATION Main Office (209) 466-4482 DATE IN TIME IN <br /> Resource Recovery (209) 982-4936 Fax (209) 465-0631 <br /> 5",L L <br /> T DATE OUT TIME OUT <br /> JOHN LUtTEFMAN 2 <br /> 22,br, GFAPHj(.-1S C�, (,1E T1 t VEHICLE ROLLOFF <br /> MODEST,C CA '!JcS l REFERENCE ORIGIN <br /> scale 1 rl e l h F 1 7 2 4.o o LFI Inbound <br /> scale t Tire weight IC72r,(.-) LE <br /> ,"lot Weight 3;; L 2 <br /> OTY UNIT 'DESCRIPTION , <br /> I-,') L!!~(! 1 : 1 DI_L�fFI RATE EXTENSION TAX TOTAL <br /> WEIGHMAS-MR CERTIFICATE THIS IS TO CERTIFY That <br /> the following described commodity was weighed measured or counted by a weighmaster whose signature is <br /> on this certificate who is a recognized authority a,accuracy as prescribed by Chapter 7(commencfng with Section 12700)of Division 5 of the Cahfomla Business <br /> and Professions Code administered by the Division of Measurement Standards of the California Department of Food and Agnculture <br /> MAN I FES T '* u`4"c NET AMOUNT <br /> ` # 1.43'794 <br /> I' # NONE <br /> �'raILE~ti # 4a2316^ <br /> TENDERED <br /> 3C-7112dUla RLf hLnL,1-a Ln ---Ad L:.P ,i1a C t 1 iUi tri t d 1 , <br /> Y I T_ 1 f i T 1 CHANGE <br /> Call <br /> Ori .e Sal`el i I <br /> CHECK NO <br /> ~ <br /> DRIVER'S SIGNATURE -� ��-� tL Com, i�recycled paper <br /> i <br />