Laserfiche WebLink
1-209-242-3051 14:12:23 07-11-2013 21111 <br /> f WILSON V& TIRE CO., INC. AEET SERVICE RECORD �i 113 <br /> U.S. TIRE SALES ` <br /> to 15 0 3 TPID 1000837 16 5 0 3 4 <br /> 11 Wilson Way The Wilson Way Tire Recap 902 Connell Tire #21 US Tire Sales #23 US Tire Sales #14 US Tire Sales <br /> '1 N.Wilson Way 1535 Market St. 2211 N.Wilson Way 2600 Yosemite Blvd. 1915 Nat/oval Ave. 6530 Franklin Blvd. <br /> ockton,CA 95205 Stockton,CA 95205 Stockton,CA 95205 Modesto,CA 95354 Hayward,CA 94545 Sacramento,CA 95823 <br /> '9.465.0281 209-465 326 109-466•x581 209-571.5611 510-B87-1282 916 385-2145 <br /> ISTOMERZ P.O.# DATE <br /> PHONE VEHICLE#� <br /> LICENSE 1� �CJ <br /> CAT10 E I�C`E 6b STATE /f ZIP CODE <br /> CUSTOMER� dTPIDnaI of perjury under the laws of the 5 DECAL# <br /> certify penalty P 1 rY tate of California that the Information provided above is true and correct In addition,1 am aware that falsification a1 <br /> this Information may result In suspension,revocation,or denial of renewal of the Waste Tire Hauler Registration pursuant to Public Resources Code section 42960 and may <br /> result In civil penalties up to$25,000 per day,per violation of administrative penalties up to 55,000 per violation per day as described In Public Resources Code section 42962. <br /> LIVER NAME DRIVER SIGNATURE DATE <br /> X <br /> CUSTOMER •' • <br /> A—E TRUCKITRAILER# LICENSE STATE ODOMETER/HUB <br /> 7 <br /> L. -$PEGIAJ-fN TRU[ 6Iq3'. ON OFF <br /> PC- <br /> ZTY, DE,9O1VPT7dff6FWQf�KOOMPLETED QTY. DaSCRIPTION OF WORK COMPLETED QTY. DESCRIPTION OF WORK COMPLETED <br /> 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 /> -*a <br /> 2 A�1Ft3 D BC)70TION FINISH MILES: <br /> tit START MILES: <br /> TOTAL MILES: <br /> Q STARTTIME: Ah9, <br /> ON SITE TIME: AM PM <br /> OUT TIME: AM PM <br /> f n <br /> FINISH TIMg: ..au AM <br /> SAD AMOUNT HAULER EXEMPTION IF APPLICABLE <br /> ❑GOVERNMENT ❑LEA EXEMPT ER <br /> ❑AGRICULTURE ❑COMMON CARRIER/BACK HAUL <br /> PICK UP LOAD DYT <br /> ❑ IMPORT FROM G Q <br /> DELIVERY OLE TIRE COUNT ❑WEIGHT IN POUNDS <br /> ❑ EXPORTTO ❑VOLUME CUBIC YARDS <br /> ❑WEIGHT IN TONS <br /> ,c narQ I artl that nder enalty of rjury under the laws of the State of California that the Information provided above Is true and correct.In addition,I <br /> VN rr� a a a the fats ficallon f his Information may result in civil penalties up $25,000 per day, per violation or administmilve penalties up to <br /> $5, 0 e viol tion er a ad scribed In Public Resources Code section 42962. <br /> o <br /> CUSTOME PRI TN CUSTOMER SIGNATURE DATE <br /> :S R e Cie v�ChT�'i )u l. 1 1. 2 13 Z ; Z PM N o ] y�E CIRCLE E.TORE LOCATION AT TOP <br />