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- WORK ORDER Ir MANIFEST <br /> ;W7 C7 <br /> � 1274877- <br /> 7T4 <br /> Wac TirP.-kI�Ld1EL Waste Tir. Gen ra or <br /> McCny Truck Tire Service Center, Inc- Name: <br /> 14,07 Lone Palm Ave. Address: <br /> Modesto,CA 95351 City: �44 State: <br /> 209-521 6221 Zip: Phone <br /> ✓J - . <br /> TPID-'1274877-01 Suffix: <br /> r <br /> Load T e: 'Whole Cubic Yard Ton Pound t <br /> Load Date; .� _ ��..... <br /> [ 9.P[ck-up count: <br /> ec _ - <br /> Dal —— <br /> I�` r'"3 RWDY '( ]Delivery <br /> Llceri5a#:`"i ,State; 7� Dot Code: <br /> [ ]REGULAWTIME [ ] OVERTIME [f),•CALL OUT CUSTOMER POfi' <br /> FLAT REPAIRS WHEELSWITCHES MT/DISMT i <br /> ,r _e ' ..-� • •^r- <br /> F i 1f JHICI E MAKE I 4• it-EAGE 'i 'C. VaIICLE N0. 4 <br /> _ :l� _�•. <br /> LICENSENO. ; <br /> ,r <br /> LOCATION: !!: <br /> MILEAGE IN I — <br /> _WORK PERFOR <br /> 0/', r ,_ - , �.• <br /> -I -c� 1, '� 1' .• G`f. .��.� ...- r A— <br /> MILEAGE OUTr""—"` • <br /> 'r.1 •.., . .: .�_...�r.._ .I*"? ;L � '`. J4, Jc `"� "� TOTAL _• _ _— _ <br /> �-, <br /> TIME IN P. <br /> , <br /> TIME OUT' . <br /> SIZE MFG_-- DOT# ---TREAD WHEEL COMMENTS <br /> .1 — <br /> 2 <br /> Customer.Si nature: Date; <br /> Drivers Slgnature:,• r. %'r'�r", zr� a°' Date:•� <br /> Drivers Name (print <br /> - �°" <br /> Customer Name rint �'',.; ,•a.� I',"vid, <br /> I nnrllly Ihnl gnanr pnnnny Of pnrlury und6r Ihn Inw.of Ih0 Rlnln of CBgrnmin Ihnt lh5 Inlbrmillvn I unify Mat Unrinr'pannny of perJury urd'!Ir Iha lnw;of Ihn 111111 Gtata Or Cnllfarnln tlwt Inn Inlvrmvllnn <br /> prvvl11 <br /> dad;noun I•Inn Irnrint,v cPcarllnn,or In dvnlarll0l mnnwal�ol Ihnllwnho•TINn IHnu orllRa elrnmoocpursuonl rn-..ullll WI pannlllnn up 1V S25 Onn'pnr dny,oar Hnlnll n op aUminiairnllva 00o9Plnz up to T5 000 y <br /> rnmaltln.u.pone p <br /> It,I11N PgMlr.po.vurCn Coda saCllnn 42.00 and mny rn:vll In Civil pvnalllee np Iv 826,000?qr riny, poi vinl;llnn per any n.An^.v bad In h'LIIIPn An:ai.,rc0(jing ano}lon 429p2. <br /> yr vldellnn nr ndmnlelmPvn ponplll9e��p In SE,000 pM vfalmvn pnr Gny ns daer,�hrM In�bliC <br /> �nnrnircn COUa erejinn 42997., <br /> [ ] Impelled Load [ '] Exported Load and Location Hauler Exemption Status: <br /> c+:f„ [ ]Government, <br /> Address: [ ]I_EA Exetrpl <br /> �" It State. � `�y [ ]Agricultural <br /> City J., <br /> . l <br /> 'w, f 1 C.nmmdn Carrar <br />