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WORK ORDER/MANIFEST <br /> 1274877- ,-­�, '-�` Il <br /> lnhc*a T�r.A..rpnpratOr <br /> Mcc;oy Truck Tire Service Center, Inc. Name: <br /> 1407 Lone Palm Ave. Address: <br /> Modesto,CA 95351 City: State: <br /> Phone: <br /> Zi <br /> 209-521-6221 p r , <br /> TPID-1274877-01 TPID with Suffix: [ <br /> Load Date: 4' ' �' an` Load Type: ]Whole [ ] Cubic Yard [ ) on [ J Pound <br /> - j <br /> Decal mpick�-up Count: <br /> #� '� - -� ••-• � — — <br /> not code: RWDY [ ]Delivery Count: <br /> License Stato:. a, --— —— <br /> r <br /> COM <br /> SIZE MFG, DOT# TREAD WHEEL _ ._ _ <br /> l <br /> z - <br /> 3 -- — - _— - <br /> - - .... <br /> 10 _. <br /> 12 _ <br /> 14 ------ <br /> 15 <br /> --- -._ <br /> 15 <br /> 16 <br /> 17 <br /> 18 <br /> Drivers Slgnature�'l r "'a-' Date f Customer Signature: ;•,f,r�. `Y ",. Date: 4-ii <br /> „ 1' i <br /> Drivers Name (print) -'~ Customer Name(print) t_,: :`- a• ,,, - . <br /> nnnlry Inn{undr!r pnnnlly of parJi.rry under inn Inwc of III 91ntn of Cnllfnmin thnl the InlNmnllan I CATllry Ihnl under penAlty of parjury under the lowe(d Inn sW le or CAllinmin that the InRRgO1F <br /> prey Tlarl ahnvn I.Ir11P Md carmcal'tinrlorllol rant n,o II orWamn•'TlraAlinn of thin Muul!,r RnaL'trollon Lu aornwInn nnul �aullldA p?nalN11 MOVE) a-up to($25,000 er l py,et in 1pnr vioation or nrlminlalrative pAfl(IMI anup 111156=0,y <br /> remit b nuopenalr+++,rdvocati • nr vlawf rn ocr d'ty Ae rfncednnd Pn Publlc R!ffinlircc Coda:onion 42`102. <br /> I <br /> Ihn Rilnllr.Ranourcr+Codn nnc1N-+n Amno and mny reeVll In aivo pAnNlan up to 37-r++,non prr day, p <br /> per v1oln115h or nrlpmistmt,ve panaldr.,up to n,nnn pnr A01611nn per day Sn dncrnbad ht ghllr. <br /> _ RooPurrn Cadn toctlon 47-9G2. <br /> ( J Imported Load [ ]Exported Load and Location Hauler Exemption Status: <br /> � <br /> ITr [ J Govemment <br /> ,oy6" ' Address: <br /> a� [ ] LEA Exempt <br /> City '`:, State: Aghoultural <br /> �, w <br /> T ~a [ ]Common Carrier <br />