Laserfiche WebLink
d a <br /> WORK ORDER/MANIFEST <br /> 1274877— �; 6 <br /> Wastd Tire Hauler Waste 76r_e_Generator <br /> , nn <br /> McCoy Truck Tire Service Center, Inc. Name: <br /> 1407 Lone Palm Ave. Address: qn 1r rA ,.,., <br /> Modesto, CA 95351 City: rr ;+,��,I..�,{': State; 1 <br /> 209-521-6221 Zip: �'') ;� Phone: <br /> TPID-127.4877-01 TPID with Suffix: <br /> Load Date: Load Type:_[1]Whole_ [ ] Cubic Yard ]Ton ( ] Pound <br /> Decal #� _ - _% i "" [-X]Plck-up Count: <br /> License :, r:` '; I I Sta�o ' Dot Code: RWDIr' ]Delivery Count: _ <br /> S17_F_ MFG. DOT;V TREAD WHEEL, COMMENTS <br /> 1 <br /> 2 <br /> 3 <br /> 4 <br /> 5 <br /> G <br /> 7 <br /> 8 <br /> 9 <br /> 10 <br /> 11 <br /> 12 <br /> 13 <br /> 14 <br /> 15 <br /> 16 <br /> 17 <br /> 18 <br /> 19 <br /> 20 <br /> Drivers Slgnature; f-'� y, Date: �j �.;, Customer Signature: <br /> Dates <br /> Drivers Name (print) �. ' {;?{. Customer Name (print) <br /> / '•- i f, '�'�'� <br /> II <br /> (hal Linder p9nelly of oerlury Llndar 1110 awe or the Stain of Cnllramli thnl I 11 Infomtanon I rerllry lltel Lnl(Ier Dennlly of pegUry tm(ler the 4me of the Slold of Callfornln thnI pin Infonnnnon <br /> prevldad dbova to vun rnd corrorl,In addition,I nm nworo that raldlfL:nll0n of Ihl9 Inrormcllen may prDvIdod nbcvn Is rruo and corrocl.In nddltlon,I nm nwrrn ilial tnlplflragM of this orormffilon nlsy <br /> rmull In anapArAlon,revocellon,or denlal of renewal of l WAatn T11A'Anular Fn�l:tmilon puminnl rnpi d1 rtMl p?ne(iWA ii pin$7 D,ODD pA,dAy.Wr vICIA1np or odmin.04 pvo pona111ar,up io$6,000 <br /> le 00 11011r;RGMIMa Cada nactlon 429,0 and may rooull In Gvll D9naPlaa up+n.,2;,npn per(lay. per violation per day a.deacrlbe(I In F l.U)II, e9uuroo Coda mcllan 42902. <br /> ppor ,vlolntlon or ndminlatrAgvA pnnpillAp up In$,,nr, por vloindon pordny ns dcecrlbDd In public <br /> RnA�LWA CnrlA AaOtlon 42982. <br /> CData [ J Imported Load ( J Exported Load and Location Hauler Exemption Status: <br /> 4 'os Address: [ ] Government <br /> mn <br /> w W [ J LEA Exempt <br /> 6A <br /> CP <br /> State: [ ]Agricultural <br /> r <br /> [ ] Common Carrier <br /> Received Time Sep, 26. 2014 6 22AM"No, 1107 �4�f <br />