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>,,�,cita.cit:DEi;r(v4ANII I <br /> C <br /> 1274877- " ' ,.._ <br /> Waste Tire Hauler ("ollera_t_or <br /> McCoy Truck Tire Service Center, Inc. N:Illlr, <br /> 1407 Lone Palm Ave. A1llhr:nt+ <br /> Modesto, CA 95351 t Ih <br /> Slatr <br /> 209-521-6221 •,11+ <br /> I'Ix:n�l; <br /> TPID-1274877-01 I I'll I will <br /> Load Date: <br /> Load Type: ( �Wholcl I 1 CtIhh lull ( I Ilal ( I'lnuul <br /> Decal # _ - <br /> —— —— — '1Pick-uH COUtIt: <br /> Eese <br /> IM <br /> )y State: <br /> �Doodn: I�WI 1Y - _-_-- <br /> I ] REGULAR TIME ( ] OVERTIME ( ]CALL OUT t:U;;I[)MI It I'1 ll <br /> FLAT REPAIRS WHEEL SWITCHES-.._- - M 1/01;'1Q41 <br /> LICENSE NO. VEHICLE MAKE- - Mil I At.I VI I IIl'1 I NO. <br /> --- <br /> �III 1 i\GE <br /> WORK PERFORMED: IN <br /> NIILI_AGE OUT <br /> I o YAL <br /> I IMF: IN <br /> MMP;OU I <br /> — --- --- ----- -- COMMENTS <br /> SIZF MFG DOT 11 VVI 11 1 1 <br /> 1 <br /> 2_ <br /> 3 <br /> 4 <br /> F) <br /> 6 <br /> 7 <br /> RE-TORQUE LUG NUTS AFTER 50 TO 100 MILES --- NOT RESPONSIBLE FOR GOODS LEFT OVER 30 DAYS <br /> Drivers Signature: <br /> Date: Customer Signature. Date: <br /> Customer Name (print) <br /> Drivers Name (print) 1110 on <br /> r r ur ur,4nr Ihn lams of Ihn 01a1n of GnlllOrnle that IIr information olnlm:+ I rovldml labove ll:Inu,lm d`COrn al j In u+11+l 011,Il+U++l IOWNO Thal Inlalp lnbual rltl llldnlh ball'allot+flay <br /> I r;arlily Thal 100ibp"natty rI ,i / <br /> Y p <br /> rnvlrJurl abnve I»Inca arul uNre61.In myldvm,I am arrarn that lolnl0c:ruon 01 Itdn n <br /> P r /aVrF.tllYin,rd 9yn1a1 r,i rnnnanl of Ihn Wnnln Ytro Haular Ro{Iintratlnn purnufnt renull cIv11 ponolllun up to$2B4OIN7 pur Jay,�+ni vInIAUUII++I N+1111111@IINIIVU�+analMn up In .+,000 <br /> rnault In mua{V0 ,,n, )fI,W'i r,al rr nrvf wal raoull In ;1,11 panaltlos up to 525,000 ar day, par v101niton per dlry uu dascrlhud In I'ubfm i�oouirn I�UJn nn+.11ull A';Oil' <br /> to the Public Raarwnri ,,do r <br /> ar vlolabon ur arUnVlM III hr„prrnrsllu,e u{ ir,S%.r 0 r 6nr•Aalaliun par drry an daacribad In ublic <br /> �.�annurre("A rrnctNin A2:><JZ Wtl:;IIJ I Ito J Dulivory Point <br /> C ]Delivery <br /> Count: — Date l I '+anal Ac.11caulc�r <br /> eratr?� Waste Tire Delivery Point WIN-40 11ra Dollvery Point <br /> WORK ORDER MANIFE,3,r [ ]McCoy Truck Tire Service Contor ( I McCoy Truck'fire Service Center <br /> 10850 Harlan Rd. 1637 E Markel B St. <br /> �{ French Camp, Ca.95231 Storktorl,Ga.415205 <br /> 1274877-6.0 01 TPID#1352986-01 Phone 209-982,0111; 11'11.)1117769'1'8-01 Phone 209-652-( <br />