Laserfiche WebLink
d <br /> WORK ORDER(MANIFEST <br /> 1274,877— <br /> Waste Tire Hauler_ MAW Me Generator <br /> McCoy Truck The Service Center, Inc. Name: <br /> 1407 Lone Palm Ave. Address: I'/'-/1 �.�ti <br /> Modesto, CA 95351 City: ��i'�'; �•' State: <br /> 209-521-6221 ZIP: �I„�� �r. Phone: <br /> TPID-1274877-01 TPID with Suffix: <br /> Load Date: Load Type: Whole [ ]Cubic Yard [ ]Ton ( ] Pou nd <br /> �s <br /> Decal fjc]Pick-up Count: <br /> License#.c�, �� "' �� J�State: Cj'1 Dot coop: RWDY [ ]Delivery Count:_ <br /> /.. i <br /> SIZE MFG. ' DOT# TREAD WHEEL COMMENTS <br /> 1 <br /> 2 <br /> 3 <br /> .4 <br /> J ' <br /> 7 <br /> 8. <br /> 1.0 <br /> 11 ' <br /> '12 <br /> 13 <br /> 14• <br /> 15 <br /> 16 <br /> 17 <br /> 18 <br /> _.._...__...._.._........ _.,,__..._.... — -- --.. .. -......... _._. .. .. .. <br /> 20 I <br /> Drivers Signature: f, .r''J Date:,_ "�;��� Customer Signature: ,� Date: <br /> tt <br /> Drivers Name (print) ( " /' 'I 1 Customer Name rint <br /> Ivarth that undnr Density of per!ury tinier tho laws or to slete of csllromw ima the Information I cortlfy Itnt under ponalty of perjury undor thn Inw2,p(lh9 EIPf@ or Carow,lI M the Informndon <br /> provlU90 91)ovo Is Iruo and aerrnct,In adAltlon, nm awnmlhot fnlalflceNon of thio Informnllon may prnvlNPrl sbpvq le In is and rorraCr,In Brltllllon,I om�owaro that fnlalllanuon of tMa Inr9rmflllt7h Insy <br /> ,ull In nunpnralon,revocation,or denial ofrenews)or the marq Tim Heiler Rq 1mretlen DWaUenl result civil pocalllr up to$25,000 Dor dov,per vlblarinn or Brlminlelretivo peniluoe up to Row <br /> Iq 111 I'Alk Reoourco Coda onerlon 4"23G0 and maV msdt In alvll Donal doe;up It$25,000 par dmi, on vlolatlnn par rlay as daacrheid In Puhllr.Re?ounce Codo saotlon 424,2. <br /> Cviolation or adminintrntiva nnNll1a9 Up In mr1nf1 pnr vlr•.Intlan pnr dav nw dosorlbpd In Pubilr. <br /> nourao Coda anotlon•t2962, _ <br /> Imported Load [ I Exported Load and Location Hauler Exemption Status: <br /> Address: [ J Government <br /> [ l LEA Exempt <br /> City State: [ ]Agricultural <br /> ( ] Common Carrier <br /> Received Time Sep, 26. 2014 6 '32A 'No, 1109 <br />