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FORWARD �l SITE +r+t T1CKfi GRID t*' <br /> 4 <br /> INCORPORATED - <br /> i f i �,2 <br /> r rLgq r 0_..ti7'7 <br /> 9991,Louth Austin Road/WEIGHING LOCATION P O Box 6336 WEIOHMASTER <br /> M CA 95336 Stogy on, CA 95206 t'. F'GC If�E <br /> tan (209) 982-4298/WEIGHING LOCATION Mar Office (209) 466-4482 DATE IN TIME IN <br /> Resource Recovery (209) 982-4936' Fax (209) 465-0631r �,q a - ,If <br /> a' <br /> DATESO - RIME OUT { <br /> ST0Cf,TQN PETROLEU1*1 t:OMI AOS �. I r E'7.` ? It.)21+4 - <br /> JAY MC 1 1 RATH -� VEHICLE ROLL OFF <br /> aTCC'KTOpi cA r?„5;3cr.z 1 REFERENCE I ORIGIN <br /> iz"TIDC>,TON PETFOL EUM CO <br /> SCale I GrOSE Weight- 74""K, LB Inbound - Charge # aei vt <br /> Scale 2 Tare LjF_ajq jt 314,+0 LB i <br /> Net Weight 4E" 76, r Li' <br /> QTY UNIT DESCRIPTION RATE EXTENSI r TAX- < � TOTAL F <br /> 21 .38 TONS Cl azz 11 So:i I b jon - i <br />"��� -��, "'�'qy. '�w',"'y"7YvY�w�wya4wA�.«,axw w�.h.s�yy..M�...k>.sk�i ar... ., r i�ie ✓:.,a S..d..rr,-v. .� ,. � .. fr-.r » _ '�nw-ei . <br /> y 1 <br /> C <br /> 4 <br /> 4 <br /> 1 If <br /> 3 <br /> Y <br /> -Jv <br /> -r r` <br /> }�} y�•(�rr r � <br /> NEIGHMAS IS TO Cf FY Jhat the following described commodity was weighed measured or counted by a welghmaster whose signature Is NET AMOUNT <br /> int rtl�c�f� �eeccog I "Mtf%ccuracy as prescribed by Chapter 7(commencing with Section )2700)of Division 5 of the California Business <br /> 3n IoTijW&� -'adriflnistered by far ( GSNiemurement Standards of the California Department of Food and Agriculture <br /> TENDERED <br /> TRAILER I <br /> 'SChedt.tle 24 hour- in adv-inae d irect 1.,, rr tth the landf'11 l r CHANCE <br /> Call (E00N1aO2-42e'8 to schedule . <br /> Drive laafeZ,,. I I CHECK NO <br /> k <br /> ' DRIVER'S SIGNATURE i��—ycled Paper <br /> I <br />