Laserfiche WebLink
1-209-242-3051 14:15;30 07-11-2013 [33/33 <br /> t WILSON AY TIRE CO., INC. FLEET SERVICE RECORD Oki ll"' <br /> U.S. TIRE SALES f _ l � 5 5 TPID 1000837 16 5 4 0 5 <br /> V01 Wilson Way Tire Wilson Way Tire Recap #02 Connell Tire l##221 US Tire Sales #23 US The Sales #24 US Tire Sales <br /> 221 N-Wilson Way 1535 Market SL 2211 N.Wilson Way 2600 Yosemite Blvd. 19.15 National Ave. 6530 Franklin Blvd. <br /> 5fockfon,CA 95205 Stockton,CA 95205 Stockton,CA 95205 Modesto,CA 95354 Hayward,CA 94545 Sacramento,CA 95823 <br /> t09-465=0281 209-465-3262 269466-2581 209-571-5611 510-887-1282 916.395-2145 <br /> :USTOMER P.O.# DATE f J <br /> PHONE VEHICLE# <br /> LICENSE# <br /> .00ATI OF SER ICE STATE A ZIP CODE <br /> CUSTOMER TPID I DECAL#-0 <br /> •1 certify that under penalty of perjury under the laws of the State of California that the Information provided above Is true and correct In addition,I am aware that falsiFicatfon of <br /> tfifs 1p{,rgy?tlan may result In suspension,revocation,or denial of renewal of the Waste Tire Hauler Registration pursuant to Public Resources Coda section 42960 and may <br /> resultlnqvll 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 42952. <br /> )RIVER-N. `E DRIVER SIGNATURE DATE <br /> V X <br /> • OR • <br /> HAKE TRUCKITRAILER# LICENSE STATE ODOMETERIHUB <br /> SPECIAL INSTRUCTIONS ON OFF <br /> . ...-_......... ...._........ ._ <br /> QJ'if." DESCRIP1CbMPLEM OTY. DESCRIPTION OF WORK COMPLETED QTY. DESCRIPTION QF WORK COMPLETED <br /> SERVICE_CALL MOUNT/DISMOUNT(S)ON VEHICLE BRASS VALVE STEM(S) <br /> FLEET INSPECTION MOUNT I DISMOUNTS)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 /> WHEEL SWITCH(S) RECONDITIONED WHEEL(S) O RING(S) <br /> PRODUCT <br /> NIS MI MILES: <br /> QTY MFO DESCRIPTION <br /> START MILES: <br /> TOTAL MILES: <br /> STARTTIME: AM PM <br /> ON SITE TIME: AM PM <br /> OUT TIME: tm PM <br /> FINISH TIME: AM PM <br /> LOAD AMOUNT HAULER EXEMPTION IF APPLICABLE <br /> ❑GOVERNMENT ❑LEA EXEMPT P<THER <br /> ❑AGRICULTURE ❑COMMON CARRIER/BACK HAUL <br /> PICK UP LOA E <br /> Q IMPORT FROMWHOLE TIRE COUNT C1WEIGHT IN POUNDS <br /> DELIVERY <br /> LlEXPORTTO ❑VOLUME CUBIC YARDS ❑WEIGHT IN TONS <br /> 1 certify that under penalty of perjury under the laws of tho State of California that the information provided above Is true and correct In addition,I <br /> �odc oervr`� am aware t 1sHlcatlon of this Information may result In civil penalties up$25,000 per day, par violation or administrative penaltles up to <br /> 0 <br /> $5,0 per-- ta on per y as described In Public Resources Code auction 42961 <br /> � � sk W c <br /> • <br /> CUSTOM6 R,5 N AM CUSTOMER SIGNATURE DATE <br /> �' o " r-�" " r j 1 kSE CIRCLE STORE LOCATION AT TOP <br /> FRece ' ved Time Jul, 11. 2010 2 ; J2PM No. 071 <br />