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M <br /> �7rrWORK ORDER/R1f�NII € <br /> -- 1274877- <br /> . I <br /> Waste Tire Hauler <br /> ., <br /> T!re Waste Tire Generator <br /> . ._ �- .,- V.�•n� <br /> Modesto, C- <br /> _ ` - - -;.:.,;�`._ <br /> ,= ; <br /> State <br /> 209-521 <br /> '~ TPID-127-18- _ • T Phone <br /> T PIIS with � �f�� <br /> Ton ( j Pound <br /> _ <br /> -- [ ]Pick-up Count: <br /> J?a ie: '�"`CCc <br /> TIME [ ] ovERTI?•,�� � RWDY — — —-- �_ <br /> C =-4 uT CUSTOMER PO= <br /> �� ��`• `'\IRS - <br /> WHEEL SI (ITCHES MT DISMT <br /> ----__ VEHICLE!-LA'CE MILEAGE <br /> "tRFORMED: <br /> II _ MILEAGE IN - <br /> - --- MILEAGE OUT <br /> -_ - TOTAL <br /> - ----- -- TIME IN <br /> SIZE MFG. DOT= TR TIME OUT <br /> =AD 11'HEEL <br /> - - COMMENTS <br /> i I i)f-\'CUE LUG NUTS AFTER 50 TO 100 MILES --- NOT RESPONSIBLE FF�- <br /> ODS LEFT OVER 30 DAYS <br /> Date: Customer Signature: <br /> „ Nanta (print) f - Date: <br /> tP ) - ' Customer Name(print) <br /> sw.tw:eitt�.I purfury under the laws o!the State c Ca! T.a a.r..',r+ .v w*jN that unmer penaity�F.cv>uti u�g�Baas alitomuapion <br /> :KrtlCt In adWtwn,I am aware mat a.v`:a£rr, s r .a� p,U xw abo%e�.'trua anti;v^ht.In ;p^.Iangtwn otf,t the f this mtorm nW l N N 3ivvtv ,rd['GO pA HZ�D'O 8d may�esuh m f tie tr,�T`re Fla �"axn Pc. ;a^t 4Rul v�ax t;es,e t�sl .scnDed^PdaN'>r Per"�CmDone�yove penalties up to$5.000ypenaRres up Io 55.000 per n tafiun Fen®; _h G x 'ape•ozya•C,.w.cea a 2962. <br /> ()elivery Count: ____r Date Waste Tire Delivery Point <br /> _ [ ]Same As Hauler <br /> +t�h �F�t)ER:MANIFEST moo' r Waste Tire Deliver,Point <br /> Waste Tire DeliveryP <br /> [ j McCoy Truck Tire Service Center dint <br /> fe-- <br /> 10850 Harlan Rd, [ ]M�OE Thick Tire Service Center <br /> $877- + B French Camp, Ca,95231 1537 E.Market St. <br /> TPID#1352986-01 Phone 209-982-0115 TPD#1 7 89 8Stockton,Ca. 505 <br /> 01one 209- <br /> Ph <br /> _. . 652-0431 <br />