Laserfiche WebLink
1-209-242-3051 14:11:24 07-11-2013 20/33 <br /> 1 : WILSON V& TIRE CO., INC. AEET SERVICE RECORD H1� <br /> b <br /> U.S. TIRE SALES / ^ <br /> I g 1 5 D TPID 1000837. 16 4 8 8 8 <br /> 11 Wilson Way T7re Wilson Way Tire Recap #02 Connell Tire #21 US Tire Sales #23 US Tire Sales #24 US Tire Sales <br /> !1 N.WllsomWay - 1535 Market St 2211 N.Wilson Way , 2600 Yosemite Blvd. 1915 National Ave. 6530 Franklin Blvd. <br /> ockton,CA`9520d Stockton,CA 95205 Stockton,CA 95205 Modesto,CA 95354 Hayward,CA 94545 Sacramento,CA 95823' <br /> 19-465-0281; 209-461-3261 200-466-2581 209.571-5611 510-887-1282 916-395.2245 - <br /> 1STOMER P.O.# DATE <br /> PHONE VEHICLE# <br /> LICENSE <br /> )CAT] OF 5 VICE STATE ZIP CODE <br /> CUSTOMER TPID DECAL# <br /> I certify that under penalty of perJury under the laws of Lha State of Gallfornla that the Informallon provided above Is true and correct.In addlltan,1 em aware that falsification of <br /> this Information may result In suspension,revocation,or denial of renewal 01 the Waste The Hauler Registration pursuant to Pubtic Resources Code soctlon 42960 and may <br /> result In civil pe allies up l0 525,000 per day,per vlolallon of adminlstralivo penalties up to 55,000 per vlolallon par day as described In Pubtic Resources Codo soctlon 42962. <br /> LIVER NAME DRIVER SIGNATURE GATE <br /> X <br /> CUSTOMER •- • <br /> >KE TRUCK/TRAILER# LICENSE STATE ODOMETERMUB <br /> .n �5 <br /> SPECIALINSTRUCT1flNS ON OFF <br /> _.............................. .. _........... <br /> _ <br /> . I <br /> w)1" Dg5CR(P7 6 QJFGUORKCOMPLETED QTY DESCRIPTION OF WORK COMPLETED QTY bkk CRIPVON OF WORK COMPLETED <br /> i <br /> SERVICE CALL MOUNT I DISMOUNT(S)ON VEHICLE BRASS VALVE STEM(S) <br /> FLEET INSPECTION MOUNT/DISMOUNT(S)LOOSE ALUMINUM STEM(S) <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 /> WHEELSWITCH(S) RECONDITIONED WHEEL(S) O RING(S) <br /> PRODUCT • <br /> Q ;; IIRPf .... DESCRIPTION FINISH MILES: <br /> ello-S START MILES: <br /> TOTAL MILES. <br /> START TIME: PM <br /> ON SITE TIME: AM PM <br /> OUTTIME: AM PM <br /> p ` Q!v FINISHTIMAn� <br /> O D AMOU T HAULER EXEMPTION IF APPLICABLE <br /> - �_ <br /> []GOVERNMENT LlLEA EXEMPT THER <br /> AGRICULTURE ❑COMMON CARRIERIBACK HAUL <br /> PI 'UP (_• D TYPE <br /> ❑ IMPORT FROM A WHOLE TIRE COUNT ❑WEIGHT IN POUNDS <br /> DELIVERY <br /> ❑ EXPORTTO ❑VOLUME CUBIC YARDS ❑WEIGHT IN TONS <br /> ,c Dote I c Ify th t under enally o parjury under the laws of the State of California that the Information provided above Is true and correct.In addition,I <br /> ,ec tr� a aware that falsification of this Information may result In civil penalties up$25,000 per day, per violation or administrative penalties up to <br /> $ 00pe lolatlan per day as described In Public Resources Code section 42962. <br /> w m <br /> • CUS ER T NAME CUSTOMER SIGNATURE DATE <br /> FSR e c e i v e d T i m e�Jul 11. .,2 O 133 2 . 0 2 PM N o, 6 71 l)SE CIRCLES TORE LOCATION AT TOP <br />