Laserfiche WebLink
01/08/2013 10:04 205-521 81 MCCOY TRUCK TI PAGE 04/06 <br /> _ e WORK ORDER 1 MANIFEST <br /> "L4 L <br /> o 1274877- 6 6 6 8 4 <br /> U14 ©car <br /> Mste Tire Ham erste Tite Genf VM <br /> McCoy Truck Tlro Service Center,Inc, Name: C, k-RV aA <br /> 1407 Lone Palm Ave. Address: 1.r 9.g Ph <br /> Modesto,CA 95351 'pl City:I.-A( State: C-pf 1 <br /> 209Z21-6221 zip, -I�t���! O Plane, -tO4 <br /> TPID-1274877-01 TPIO With Suffix;13 4 <br /> Load Date: 1 i �� Load Type;%pl Whole I ]Cubic Yard f I Ton [ I Pound <br /> Decal# f a - 001 "C 46 1 �]Pick,,up count, ____ - <br /> 6icensP I State:G,a pot Cada: RWDY I ]Delivery count, <br /> �J REGULAR TIME f ] OVERTInAG [ ]CALL OUT CUSTOMER PO# <br /> FLAT REPAIRS WHEEL SWITCHES MTIDISIVIT O <br /> LICENSE NO_ / 2- 10437 VEHICLFz MAKE`k�-t-- MILEAGE //�>'---> vEllICLE NO. 13.'�;1]( <br /> LOCATION: 11Ti�j5rj y--N Soh �� <br /> WORK PERFORMED:,�.1�N' � % 7 L M MILEAGE IN 7� <br /> M+, N � MILEAGE OUT d `� 3,.. <br /> -—_= TOTAL ._.. ,., <br /> TIME IN.. ..��_.. .._� <br /> TIME OUT 3 :4-1 <br /> _ S12E_ MFG. DOT# TREAD WHEEL Cokpg .TS <br /> 2 <br /> 4 <br /> 6 <br /> 7 <br /> p�vers Signature: Date, ]�J Customer Signature; / Date, <br /> Drivers Name(print '�'�L' `' Customer Name(print) � J <br /> I ngrtf Ihel under n"n of pn h updef fhe�dWa o7 @o amts V10" <br /> f galtlore+e III at thq Irdormmlon I cyHlffy1nM rmdur penal of R�rJury under fp Iowa M Inn m,an of CalfMrnla Innl tnm Irrom+nnpn <br /> Dtavl�d above h tnx a d enrmal.In eddltltl, I nm nv,Pra mNX,1 tf40 Ion of thle Intnrrnnrbn Tey DrovkfAd nbv+n I4 uuP P C•In addltlan,II'.w'nwnm Ihsl Mle fiedllen of Ihtn Inrnrmellon AMv <br /> duh In 7u'JDonalen,rl1vOCMIOn,or ,danlal of ISlnnwal w inn lNp a The Wauim R Inlrnnn�pweuent raeult aNn RM MA up 1 2'7'D pert day,par vinlnDop or edmin��oeallvn pnnmm�n up;0 55,000 <br /> to a+n Putllic R0e0ulEe CQG�n nCutlon e2p5q Pry�111Y fesull In "18p1mPRIPP Ilp M'a0, t)0�fef day, pqr uk,lntlpn ph dny ae n:cdhao m PUHOC RgtYvvra�Cada oomtah 4?GA2, <br /> pq.vloiellM M adnllnletMvrl nam Pe up 101�,0'10 Por vlolollOn par oay aP d�OC/fbe�In Puhl�c <br /> I?esauree�odn^ntllona7,�6x, <br /> f ]Imported Lwd [ ]Exported load and Location Hauler Exemption Status: <br /> Address, I ]Government <br /> I 1 LEA Exempt <br /> City State: ( ]Agricultural <br /> I ]Common Corrier <br /> Received Time Jan. 8. 2013 2: 25PM No, 0409 <br />