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i <br /> i <br /> 1274877- <br /> H a u <br /> ler <br /> 27877-Mauler <br /> Waste Tire Generator <br /> Phone <br /> -2 <br /> erg OdtF -2 ., , ti <br /> [�Decal - -- <br /> License ]Pick-up Count: <br /> - RVVDY - - <br /> [ � REGULAR TIt,1E - <br /> FLAT REPAIRS - <br /> -� '�"�`�'=-_ t.;TDISR1T <br /> LICENSE NO. <br /> '•'�•� _ MILEAGE VEHICLE NO _ <br /> LOCATION: _ <br /> WORK PERFOR%IED. <br /> MILEAGE IN <br /> MILEAGE OUT <br /> TOTAL <br /> THME IN <br /> TIME OUT <br /> SIZE MFG DOT= TREAD WHEEL COMMENTS <br /> 1 <br /> 2 <br /> 3 <br /> 4 _. <br /> 5 - - - <br /> 7 <br /> --- NOT RESPONSIBLE FOR GOODS LEFT OVER 30 <br /> RE-TORGUE LUG NUTS AFTER 50 TO 100 MILES <br /> Date: Customer Signature: Date: <br /> [)rivers Signature: <br /> Customer Name (print) <br /> Name (print) <br /> ()rIVC(S may provideo aoc+e:s n,e a"'d Comte.In addnen.I aT sears -,a to a nvn c tn:s n orrnat, may <br /> Ihnl undor penalty of per)ury under the laws L^.e Ott fa;1 caffi ion &at o^ I `f tna!ender pana.y o'parruni under toe la es a are <br /> S3 a ��.�z�a^at:tie�ntorma nn <br /> llfy In amnion.I am aware <br /> Wlriod nUovU is true and prT ;t dental of renewal cj rra yv,aste Tire Hauser Registra:ar!p+-rs;;art resort a�I pens^.res S��SS ` Rerscw<•ce Code se..t�on s�qt�na.res u,.to 5.x,00 <br /> 12960 and may result m cmi pena9ces up to 525.&Pt�day per o ation per oay <br /> rr,ninbed <br /> III In.,urep" !,ou•e o d net S up to 55,000 per),Imat)on Per cav as desxr�ed <br /> Ir r 11!n 1'ul,llt:HegpUfCn code SeGtiOn <br /> r vlulydlrn,or nsiQddon 42fvO 96 Waste Tire Delivery Point <br /> I;`r`�'rrr"rr crude Date [ ]Same As Hauler <br /> l(Wivery Count: <br /> `�p,�T Waste Tire Delivery Point Waste Tire Delivery Point <br /> J, [ 'J McCoy Rd.Truck Tire Service Center [ ]McCoy Truck Tire Service Cente <br /> WORK ORDER/MANIFEST �� 1537 E. Market St, <br /> 10850 Harlan <br /> Stockton, Ca.95205 <br /> .... � :rsr� French Camp,Ca.95231 --_ _ T^ L.__,--- -- <br />