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I ' <br /> _ET SERVICE RECORD <br /> WILSON WAY TIRE CO., INC. 17 1__ 46 <br /> ». <br /> U.S. TIRE SALES TPID 1000837 <br /> 07J US Tiro sales 024 US Tiro Sales <br /> 021 US Tire Sales 1915 National Ave- 6530 kanklin Blvd. <br /> Wilson 1Ltp•Tire WJ1son Way Tire Recap 1102 Connail Tre 26C0 Yosemde Blvd. S:I_am.nto,CA 95827 <br /> (N,1Ylso'i"y f575 Markrr Sr 2211 N.W450n Way MOd05fd,CA 95354 Hayward,CA 94545 pi6-39S221S <br /> 'nck inn,CA 95205 Sfocklon.CA 95205 Stockton,CA 95705 209-57f-5617 57o-887-1282 <br /> )p-a65-0281 _ 209-465-7262 109J66-2581 DATE ) <br /> PO a <br /> .2- /30j <br /> VEHICLE 0 �1o� <br /> PHONE 1� <br /> ._ LICENSE# <br /> STATE // BODE <br /> or SERVICE <br /> (/� <br /> 1 DECAL# l 3 C� t� P0 <br /> CUSTOMER TPID ) !) f t; ! — % <br /> 1 cen1f)that under penalty of perjury under the laws of the Slats of California that the Into rmatlon provided above Is true and correct In ounceaddition,I de aware that ie1e1 f <br /> I his Inlormation may result In suspension,revocollon,or denlal of renewal of the Waste Tire Hauler Registration pursuant to Public Resources Code section a ae a o <br /> result in dull penalties up l0$25,000 per day,per violation of adminlstrative penalties up to 55,000 per violation per day as described In Public RDAT ureas Code se cti <br /> VER NAME i ! 1 DvRIVEf2 S1CTN U �.� C <br /> r.J I; <br /> TRUCK/TRAILER p _- LICENSE STATE ODOMET <br /> SPECIAL INSTRUCTIONS ON OFF <br /> _--.-_ - <br /> 1 • <br /> OIY DESCRIPTION OF WORK COMPLETED QTY. DESCRIPTION OF WORK COMPLETED_+ QTY`'. DESCRIPTION OF WORK o LE7ED <br /> I SERVICE CALL MOUNT/DISMOUNT(S)ON VEHICLE BRAfSTEM <br /> STEM(S)O <br /> FLEET INSPECTION MOUNT/DISMOUNT(S)LOOSE ALUEMS) <br /> AIR SERVICE LOOSE MOUNT(S) VALREBUILD(S) <br /> FLAT REPAIRIS) LOOSE DISMOUNT(S) ALLIGATOR CAP(S) <br /> REPAIR MNFI ERIAL(S) TIRE(S)BALANCED. METAL VALVE CAP(S) <br /> '.rrHEEL SWITCH(S) RECONDITIONED WHEEL(S) O RING(S) <br /> PRODUCT INSTALLED <br /> Dom! I S-2E MFG > bSt?RIPT7 +�'aYns"'�i ? IJ;t y FINISH MILES: <br /> START MILES: <br /> itTOTAL MILES: <br /> START TIME: ADS PM <br /> I <br /> ON SITE TIME: ANI PM <br /> OUTTIME_ AM Ptd <br /> FINISH TIME. Ara PNI <br /> s LEAD AMOUNT _ _ �. QKIP"APPLICABLE _ <br /> :]GOVERNMENT Q LEA EXEMPT Q OTHER <br /> ❑AGRICULTURE <br /> L)COMMON GARRIERJBACK HAUL <br /> _ ;' . . .:.� .,� �,�-• �v�� � 114 <br /> 0 WEIGHT IN POUNDS <br /> 14WHOLE TIRE COUNT <br /> I ' <br /> ❑VOLUME CUBIC YARDS ❑WEIGHT IN TONS <br /> n+rT lh',t:",der natty of perjury undw the to"r "thio State Of Ceilf..I�het the Information providod above is true and correct.In addll <br /> I•e V;)I falsificatlonw'tbis WOMMUCA 0.'104id(In dMI pettatklej Op $25,000 par day,per violation or administrative penailies I <br /> r,Wlonper(Jay[ld0zCdtkeQ PubIkRM4�f0�iClSdeeectlrsn�2982. <br /> NAME "' CUSTOMER SIGNATURE DATE <br /> - �I•Nr• 1• ,'ri!.:1 r'�Kgsrr VI MIA �Vrtll�Ny+♦�twf <br /> it_146h <br /> pot drypdelCC�lidIrlPUbllitAMl6uM Code section 42902. <br /> OF <br /> 1 t dr <br /> fA <br />