|
J 4
<br /> WILSON' A`' TIRE Oa9 INC.
<br /> FLEETSERVICE�RECORD
<br /> U.S. PRE SALES �' ��
<br /> « 7TPID 1000337• -J�A�,7 4l
<br /> #01 Wilson Way Tire Wilson Way Tire Recap #02 Connell Tire #21 US Tire Sales #23 US Tire Sales #24 US Tire Sales
<br /> 221 N.Wilson Way 9535 Market 5t. 2211 N.Wilson Way 2600 Yosemite Blvd. 1915 National Ave. 6530 Franklin Blvd.
<br /> Stockton,CA 95205 Stockton,CA 95205 Stockton,CA 95205 Modesto,CA 95354 Hayward;CA 94545 Sacramento,CA 95823 i=
<br /> 209.465.0281 09465-3262- 209-46&2581 209-571-5611 510-887-1282 916.395-2245
<br /> CUSTOMER P.O.# r DATE
<br /> PHONE VEHICLE# �
<br /> LICENSE# 1 rh
<br /> LOCATION OF SERVICE } STATE ' Zt CODE
<br /> cm o ry?c (J G, G - 4
<br /> CUSTOMER TPIDJJ �i � r_J DECAL# ! ,�
<br /> I certify that undgr penalty of perjury under the laws of the State of California that the Information provided above is true and correct.In addition,tam 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$5,000 per violation per day as described in Public Resources Code section 42962. r
<br /> DRIVER NAME DRIVER SIGNATURE DATE
<br /> nSr
<br /> MAKE ry t J TRUCKfTRA1LERli r LICENSE
<br /> STATE ,fODOMM�ETERIHUB
<br /> tZ
<br /> �y-Aoi
<br /> • ..�,,..: ;rSP, ,.kA4.�iVS.Rl1t"�'.Q?�. " ..�,:-�- N - g;��
<br /> ----------- -- ..-- - -- ----_.... —
<br /> _
<br /> 7
<br /> l�T ON� ,ted .t�'t Yw•z5•= .� 1rF2 P.. OlV`' f�if Pl="
<br /> _- ,,.
<br /> SERVICE CALL f'` MOUNT 1 DISM �SS VALVE STEM(S)
<br /> FLEET INSPECTION MOUNT I DISMOUNT(5}LOOSE ALUMINUM STEM(S)
<br /> AIR SERVICE LOOSE MOUNT(S) VALVE STEM REBUILD(S)
<br /> FLAT REPAIRS) LOOSE DISMOUNT(S) ALLIGATOR CAP(S)
<br /> REPAIR MATERIAL(S) TIRE(S)BALANCED METAL VALVE CAP(S)
<br /> WHEEL SWITCH(S) RECONDITIONED WHEEL(S) 0 RING(S) 1
<br /> FINISH MILES:
<br /> SH
<br /> ..6",Ea13:•�.•.(•. < d_
<br /> QTY: -rSIZE".:�: .s MF.
<br /> O.
<br /> r "raves" ,'-: !) SCftt'PTi01Q;: t:sa;= ?h"c` s g g.
<br /> w 00 r �..r a ~� START MILES`
<br /> TOTAL MILES: { M
<br /> Ale ;J ✓ STARTTIME d i S&t?M. •;
<br /> ONSITE TIMC--: AM PM
<br /> OUT TIME: AM PM '
<br /> tj
<br /> FINISH TIME: PM
<br /> ..t,. :i, _ �s may. .,�;�.v: _ :;r...,::.
<br /> iy
<br /> _N.Y•:;2- .h;f. "7ay.a j.C;:*. —
<br /> ........-:-.......:... ............,:,.:,••.;.� -._ ., a°�•�+<,.?3..-�' ,�j.:E ;GMP^aI01V:11.3v' :cF'�1' 1E'���"^��`' ,on,.su,a
<br /> LOAD AMOUNT v4,,,.,..._},�...:.�,,!::._....,_.,.,,...,;,x ., . ::,.. ,.......,._i�>�•1,I. .R T ,��.� C.�:96 .•.4:.a.�•,.;:e;,�. ._.
<br /> ®GOVERNMENT ®LEA EXEMPT D OTHER
<br /> ———— ®—— ❑AGRICULTURE 0 COMMON CARRIER/BACK HAUL
<br /> S.`/%; %'-'3'a•;';i `Mr'"'��rc•.r a�aa'tFr:• "q+:iHn •`'-`$�."'„.la<n?.•'>Gt ^;zj.:>
<br /> '1 rnc �'~} ry1Jr'1 7' '::'fi:.,•.r;; ••,d..- 7y.e:cK y;.Yu4:3 i;'?r:6'�.a +•>
<br /> ❑,PICrK UP
<br /> IMPORT FROM t .� .J +
<br /> (3 DELIVERY WHOLE TIRE COUNT ❑WEIGHT IN POUNDS
<br /> © XPORTTO7- `� ❑VOLUME CUBiC YARDS ❑WEIGHT IN TANS
<br /> Z rf i r l
<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,l';`
<br /> or��DatgTr am aware that falsification of this information may result in civil penalties'up$25,000 per day,per violation or administrative penalties upgtti:
<br /> °d $5,000 per violation per day aVdeScfibed In Public Resources Code section 42962• 1.
<br /> CUSTOMER PRINT NAME CUSTOMER SIGNATURE DATE
<br /> R N®, 14721
<br />
|