Laserfiche WebLink
WORK ORDER / MANIFEST <br /> �2 <br /> A 274877- 4 G 4:5 <br /> Waste Tire Hauler Waste Tire Generator <br /> McCoy Truck Tire Service Center, Inc. Name- C <br /> 1407 Lone Palm Ave. Address: <br /> Modesto, CA 95351 City. 'zP'. State:(�'A <br /> 209-521-6221 z i P:'"�) 's,-— Phone: <br /> TPID-,1274677-01 TPID with Suffix 1 0 <br /> Load Date, Load Type: Whole Cubic Yard Ton Pound <br /> Decal [y] Pick,up Count: <br /> License RWDY Delivery Count: <br /> .I State: Dot code. <br /> SIZE MFG. DOT TREAD WHEEL COMMENTS <br /> C-'7% 7D V--- <br /> 1 <br /> 2 <br /> 3 <br /> 4 <br /> 6 <br /> 7 <br /> 12 <br /> 13 <br /> 14 <br /> 15 <br /> 16 <br /> 17 <br /> 19 <br /> 20 <br /> Date: <br /> Drivers Signature Datek i-i. CuStomer Signature: "'01 P%m Vlfm�K� <br /> Drivers Name (pri Customer Name (print) <br /> I Cdfilly 11101 undai poiially ol pbrjury under Ilic uW0 01 1110 SWO Eulliorrd�thdi uw ln(crmuLor I ci�rllly thut widw p6nully cl pquty urtdci 11he lawb 01 IN)610io 01 Mliloallil=1 IN n1cirmallon <br /> ,i cv�d cl ubovu iz ruu und oorract,In addillon,I aIll bWofd 111di 11111.111cakm ol 1116 Inlorinz;i0on y picv1U%%i Wvvjj,13,�ruc,rim cpnrycl.in c,acli=i,I uxn awuiu Owl InUllcui,ion DI IhIa Infuniiallun iiwy <br /> -IUJI I r '�6'wfj W.r ddv.p.,Violcillon 0i;'r:;MI11zII0IIW J-X)1141110�;�p <br /> 'uyC��JiL-jj,ut d-ldl%)I f8ilvWal 01 VIQ W14UK'I*IIU I d 4CYLetralien pullludLln rwcLill lfi civil pd id wi up w <br /> r' <br /> io Flulhe Auuourzu Codc�acllan q2Xo ona rrLy rujull hi civill ovindilloo Lip 10 Z.25.000 lj��l Juv.pul poi Wo'cillon p�)r d4ty 6,D docrlrjoO in PuWic Fi=urcc CDdU wairm 42�=. <br /> olA111L)n�,i pdniInl;Ai&t1vo punallim up lu$5 Goo pQi vialulicn pbr duy mu demuribbd In Public <br /> R­cu'c�Cudr 42110 <br /> at Imported Load Exported Load and Locatiorl Hauler Exemption Status: <br /> Address, Covernment <br /> c, LEA Exempt <br /> City: State: I <br />