Laserfiche WebLink
1-209-242-3051 14:05:38 07-11-2013 4/33 <br /> 1 0 1 1 , , WILSON W TIRE CO., INC. rLEET SERVICE RECORD qjj[I� <br /> U.S. TIRE SALES TPID 1000837. 165249 <br /> 1. (san Wa}t'T.Ire Wilson Way Tire Recap #02 Connell Tire #21 US Tire Sales #23 US Tire Sales #24 US Tire Sales <br /> I'NWilsoli YVay- 1535 Market SL 2211 N.Wilson Way 2600 Yosemite Blvd. 1915 National Ave. 6530 Franklin Blvd. <br /> CktOn;t:A_9205 Stockton,CA 95205 Stockton,CA 95205 Modesto,CA 95354 Hayward, CA 94545 Sacramento, CA 95823 <br /> 1,465-0281 - 209-465-3262 A209-466-2561 209-571-5611 510.887-1282 916.395-2245 <br /> 3TOMER SOS P.O.# DATE 0 <br /> PHONE VEHf LE# /1 <br /> LICENSE# <br /> :AT N OF SE VIIC�E7 STATE <br /> �J /- ZIP CODE <br /> CLool <br /> CUSTOMER.TPID J �' I�,ll„ —1 DECAL# —;�— <br /> I certify that under ponalty of sr1%under the laws of the State of California that the Informatlon provided above is true and correct.In addition,I am aware that falsification of <br /> this Information may result In suspension,revocation,or denial of renewal of the Waste Tire Hauler Registration pursuant to Public Resources Codesection 42960 and may <br /> result In civil penalties up to$25,000 per day,per violation of administrative penalties up to$5,000 per violation per day as described In Public Resources Code section 42962. <br /> VER NAME DRIVER <br /> IVER SIGNATURE DATE <br /> CUSTOMER •' • <br /> {E TRUCK/TRAILER# LICENSE STATE ODOMETER/HUB <br /> l 7 <br /> SPECIAL INSTR 698 ' ON OFF <br /> 62 4a- C// <br /> vv,s <br /> ITY. DEBCR1P710 OPWORK b6MPLEM QTY. DESCRIPTI RK COMPLETED QTY. OESCRIPTIONOFWORK COMPLETED <br /> T- SERVICE CALL MOUNT/DISMOUNT(S)ON VEHICLE BRASS VALVE STEM(S) <br /> FLEET INSPECTION MOUNT/DISMOUNT(S)LOOSE ALUMINUM STEMS) <br /> AIR SERVICE LOOSE MOUNT(S) VALVE STEM REBUILD(S) <br /> FLAT REPAIR(S) LOOSE DISMOUNT(S) ALLIGATOR CAP(S) <br /> REPAIR MATERIAL(S) TIRE(S)BALANCED METAL VALVE CAP(S) <br /> WHEEL SWITCH(S) RECONDITIONED WHEEL(S) O RING(S) <br /> PRODUCT • <br /> 1TY. " "' FINISH MILES: <br /> DESCRIF7ION <br /> START MILES: <br /> TOTAL MILES: <br /> START TIME: AAA PM <br /> (, ON SITE TIME: AM PM <br /> 21 <br /> OUT TIME: AM PM <br /> FINISH TIME: M <br /> )AD MOUNT HAULER EXEMPTION IF APPLICABLE <br /> ❑GOVERNMENT ❑ LEA EXEMPT THER <br /> ❑AGRICULTURE ❑COMMON CARRIER/BACK HAUL <br /> PICK UP LOA E <br /> ❑ IMPORT FROM WHOLE TIRE COUNT ❑WEIGHT IN POUNDS <br /> DELIVERY <br /> ❑ EXPO RTTO L ❑VOLUME CUBIC YARDS L)WEIGHT IN TONS <br /> I certify that under pe ally of porlury under the laws of the State of California that the Information provided above Is true and correct.In addition,I <br /> 'otJ°Data... am aware that t Illc I of this Information may result In civil penalties up$25,000 per day, per violation or administrative penalties up to <br /> 55,000 per violatl n er s e6cri bed In Public Resources Code section 42962. <br /> m' <br /> CUSTOMER PRINT NA CUSTOMER SIGNATURE DATE <br /> WReceived Time-) Jul. 11, 2013 2 ; 02PM ''No, 07' 93ECIRCLESTnRPInr:ATInNATTOO <br />