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t 31/08/2012 10:04 209-527. '21 MCCOV TRUCK TIS PACE 02/0b <br /> WORK ORDER I MANIFEST <br /> 1274877- 68991 <br /> Q� •� i-hg'L -1 <br /> 38Ia-s1�T�f�u,leL � _wa�t�Tlr� . <br /> McCoy Truck Tiro Service Center, Inc. Name; �e�Y Mafe !` <br /> (I(s- <br /> 1407 Lana Pelm Ave. Address; �� a y,tf Rd <br /> Modesto,CA 95351 City: I- <br /> Statwcdk <br /> 209-521-9221 i ip: Q Phone--Z �l 7` 101 d <br /> JUL 11 18%ID-1R7.4977-01 TPID with suffix.- C ORO-9-01 <br /> Load Date; 14 Load Type. *hoia r i Cublr.Yard i 1 Tin f 1 pound <br /> Decal# `/Olck-up count: <br /> License S#7Li&7?o2 IstatECa- Dot code: RWDY [ ]Delivery count: <br /> P t.EGULARTIME [ ) OVERTIME [ I CALL OUT CUSTOMER PC# <br /> FLAT P,EPAIRS WHEEL SWITCHES MTIDISMT <br /> LICENSE No. )EH ICLE MAKV—b .MILEAGE 3a> l vEH1CLE No._�', <br /> LOC. ATIONA ne k al-Y-d <br /> OCl�t�PERFpRnAED; _ MILEAGE i1N �J _ <br /> r•� �" r <br /> _ �_— _ <br /> 651 <br /> M..r�.f. + 0 JP %��Q=C�I�. ,� _ l- AGE rJUT <br /> ...., <br /> aTAL <br /> _. <br /> ,TIME,IN q......�._ , _ <br /> ti r <br /> �(r _5TIME OUT <br /> 52f; MFG. OT# EAD WHEEL CWMENTS <br /> 'r.4W�! <br /> 1 1 <br /> -� (-G :4 ' <br /> 3 <br /> 4 <br /> 5 <br /> 7 <br /> Drivers signatU4. r at -0 -Thamer Signature: 1 i 1V� Dete: <br /> Drivers Nome tint f_.S/_�� Customer Name(print)-*I <br /> I ee!I�he1 unear pnne�y of De ry drder mn mesa of n��nonle of CaMkmin Innr thq l*kmaMon aanl d1P1 Ander penmly of pnr�uy unhpr Ing I( 0}Naf caumrnln i I(l1�Ynformudan <br /> u oewa is t ie end cu"Z !n eGQafan,I elt+pW�C,ni fz 511.1rtllan or tl1�n IRiort*atlon m� p•euld, nhove le truo edd-a Conner.In annntnq I q 5�waro tnnl Ip1.7Menllryn 0}Inde n ormonon mn <br /> Remit h1 xnrtpen8lOn re.owb'nn,or annlnt nr I.-Mlle iho Waatn Tl;n Mnulpl rjRAlet�adE�PtROunnt IBMQ`'li Oena11a-U%10'$75,0(14 pBt as pq��Iml tion��amlMAtrl1A'.'E Da1111i1�e7 up to Kw)Y <br /> m mp ruellc Recw oa Godn aaatl?�1 A2B90" maV rnaull In tiv l(�pt1}1}I11e u0 l0 373,GQa�ar AAy, 0M�Idatbn par dny An R«PCrlh W In Puh110 Ra7au cn Cone q!wUon.1. 61 <br /> ger vi0relhln M aammtrdmrl 9 tnnq Ilea ua to G.QO pnr Nnlagpn pM eery as dosarlbaa in 4114 <br /> 13osovrca Coda anf.'llan i9P, <br /> i 1 Imported Load ( ]Exportoel Load and Location Hnuler Exernption Stotus: <br /> Address: [Government <br /> be [ I LEA Exempt <br /> City State: [ )AgricultuMI <br /> f 1 Common Carrier <br /> Received Time Jan, 8. 2013 2: 25PM No, 0409 <br />