Laserfiche WebLink
� w <br /> WILSON WAY TIRE CO., INC. FLEET SERVICE RECORD <br /> U.S. TIRE SALES ENTERED TPID 1000837. 18 7 6 6 4 <br /> itWilson Way Tire Wilson Way Tire Recap #02 Connell Tire 923 US Tire Sales 9241 S Tire Sales <br /> 22�N.Wilson Way 1535 Market SL 2211 N.Wilson Way 2600 Yosemite Blvd. 1915 National Ave. 6530F.. Blvd.j <br /> Stockton,CA 95205 Stockton,CA 95205 Stockton,CA 95205 Modesto,CA 95354 Hayward,CA 94545 Sacramento,CA 9 }23 <br /> 209-465-0281 209-465.3262 209-466-2581 209.571-5611 510.887-1282 916-395-2245 iJ <br /> CUSTOMER P.O.# DATE <br /> PHONE VEHICLE# <br /> l3 '� <br /> LICENSE# <br /> LOCATION OF SERVICE ` a <br /> C STATE ZIP CODE <br /> CUSTOMER TPID —_7 r 171- 6 ( ' DECAL# —�- <br /> I 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 falsification of <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$5,000 Kr lation per da as described in Public Resources Code section 42962. <br /> IDRIVER NAME DRIVER SIGNATUR <br /> DATE <br /> xCUSTOMER VEHICLE INFORMATION <br /> ?S3-/ <br /> MAKE TRUCK/TRAILER# LICENSE STATE ODOMETER/HUB <br /> d SPECIAL INSTRUCTIONS , =ON OFF <br /> �t�►s of��. i Cf2A (c oil�5 r n� UJ a1�7 - —- ----- -- <br /> �� /{i`�ki it Q+1�'t rriy 7�'!;t !C E• �llt4 f — C�SEs I <br /> OTY. DESCRIPTION OF WORK COMPLETED QTY DESCRIPTION OF WORK COMPLETED OTY DESCRIPTION OF WORK COMPLE—rED <br /> SERVICE CALL MOUNT/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 <br /> METAL VALVE CAP(S) <br /> WHEEL SWITCH(S) RECONDITIONED WHEEL(S) 0 RING(S) <br /> QTY SIZE MFG DESCRIPTION FINISH MILES: <br /> START MILES: <br /> TOTAL MILES: <br /> START TIME:_ 5 5(3M PM <br /> ON SITE TIME: GO Sin 6 PM <br /> OUT TIME: �Z MIA Q PM <br /> FINISH TIME: PM <br /> LOAD AMOUNT HAULER EXEMPTION IF APPLICABLE <br /> gyp_ ❑GOVERNMENT ® LEA EXEMPT ❑OTHER <br /> yam- ❑AGRICULTURE ❑COMMON CARRIER/BACK HAUL <br /> ICK UP -/ LOAD TYPE <br /> ❑ IMPORT FROM ` <br /> DELIVERY d WHOLE TIRE COUNT ❑WEIGHT IN POUNDS <br /> :1 EXPORT TO - EJ VOLUME CUBIC YARDS ❑WtIGHT IN TONS <br /> pQiQ I certify that under penalty of perjury under the laws of the State of C is that formation provided above is true and correct.In addition,I <br /> ort T� ahi aware that falsification of this information may result in civ!I nalti p 0 0 per day,per violation or administrative penal'es up to <br /> o� 55,000 per violation per day as described in Public Resources bdo ction <br /> w m <br /> CUSTOMER PRINT NAME CUSTOMER SIGNATURE ATE <br /> FSR No.1 87666 PLEASE CIRCLE STORE LOCATION AT TOP <br />