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<br /> �y�'�B��rtl ��L,,A11 � 'T/- •?�" \`�\^\`fir �,I�
<br /> waste Tire _ I ,',• I;i� ,
<br /> McCoY THauler
<br /> ruck Tire ServiceVV„•.11, 1 Ili,
<br /> 1407 Lone Palin Ceraler, In.Ave. N:nnt,
<br /> Modesto, CA 95351 \,1,n(,r,•,
<br /> 209-521-622-1
<br /> LeadData -01 PID-1274877I'
<br /> Dwill :oullr,
<br /> �C�I # Load Typr,: I ]Wlujlu
<br /> I I(allllr lulrf I I lull I �I'rnnul
<br /> License --
<br /> [ ]REGULAR TIME State: Dot Cor1(• -��1N1)�' �f'i1:k It11 (:111411
<br /> [ ] OVERTIME [ J CALL OUT CUSIc)MI I I'1 u1
<br /> PLAT REPAIRS
<br /> ---- WHEEL SWITCHES
<br /> LICENSE NQ — M Irl 11:;M I
<br /> LOCATION ---__-_ VEHICLE MAKE MII I A1;1
<br /> \/I I III I I I Ir r
<br /> IVORK PERFORMED: —
<br /> Irdll 1 Aid Ill
<br /> r,111 I NIH I It I I
<br /> It IIAI
<br /> I IMI 111
<br /> 1 11"41 l u 11
<br /> SIZE MFG DoT# (READ
<br /> wt-IEr-I r IjrvlMllll•;
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<br /> RE-TORGUE LUG NUTS AFTER 50 TO 100 MILES --- NOT RESPONSIFII I I I jP I it II 111', I I I I 11\/1 I• III I1/� r '.
<br /> Drivers Signature: Date: Customer Signallulo. 11x,1„
<br /> Drivers Name (print) Customer Nan o (print)
<br /> A,Idy L^ol under penally of porlury under Iho Inwy rf Itv,,adn it Cahfunu I that It Information I cattily dun undw prnudly nI 1 Imdw Ilm Inver rd un,111.0,„i ,die,.,,i•,ural a,•,I•, $e.,,
<br /> v,r:ad aCov9 is true and correct.In addition.I am aware that frjoirabnn of ails inionnallon may provided abnvo In It ;unl r,nn,r 1 In n,ldtllrm I ern n,r,•rn n,nt I,d.,m„u...r,,d u...,,,,i.,,,,,.,e.,........
<br /> suspens,on,revocation,or dental of ronewuf of fha Wa-,In Iaq I1111Ar Roybiraeon pursuant rosult civr7 ponaltloa up In s,,!,,IIu11 pet deli vl•Jnp,•n ry n•L•n,d,n,.0 ...,,.,u,...„I.„ �, „n,
<br /> Ire PuC6c Resourw Code section 429,130and mr1y,roaull in uvil famrdlme up Iii$25,(M per day, pm violation por(lily n1”doprrllmd In 1'46114�nn
<br /> t«,rine,.,r„•L,-.••1"e••,,^n
<br /> v.ofat�on a adminrslrative penalties up Ie Sl;yl pat vvAalien per(jail at donrnhed in PuMIc
<br /> .sc,,re Code section 429112
<br /> ( / WPIsJn lisp,J b;iilt•lil t'i't til 11
<br /> r )Delivery Count: _ __ Date I i 1;I11111n Ai,I llmltsl
<br /> Waste Tire Delivory Point fila 1 raliar,l l, 041111
<br /> ,,,YORK ORDER/MANIFEST "��^ (,.j`McCoy Truck Tire Sorvico Contor I I MI!.1IV I nit H Illy taaltill•n t ulflal
<br /> B
<br /> 10850 Harlan Rd. 1 ri 1/ t' Mal l-III cal
<br /> ¢ ! '" ;+,lU French Camp, Ca.95231 r.11if 1,llul, I 11 uh;
<br />
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