Laserfiche WebLink
WILSON WAY TIRE CO., INC. FLEET SERVICE RECORD <br /> • U.S. TIRE SALES TFID 1000837. 13 7 9 7 0 <br /> 001 GUHson tSley Tire Wilson Way Tire Recap 902 Cantwi Tire #21 us TIM Sales #23 US Tire Sales Ata US Tim Setas <br /> 221 N.Wilson Way 1535 Market St 2211 N.WAsan Way 26W Yasemfte Blvd. 1813 National Ave• 6530 FmnkUn Blvd <br /> Stncktan,CA 95206 Stockton,CA 95206 Stockton,CA 85203 Modesto,CA 93354 Hayward,CA 94450 Sppaazento,CA 65823 <br /> 209-465-0281 209.469.3262 203.48&2581 208-671.5611 610.887-1282 9163952245 <br /> CUSTOMER / /J f/ P.0 f!�_•^"li Z— ^ DATE 6 `A QA PH'j/O~1JNE 1 VEHICLE ! <br /> LICENSE 0 <br /> tom.ted ge;;,P4� <br /> LOCATION OF SERVICE / STATE Z1P CODE <br /> CUSTOMER TPID ;1iL '�..—�3 DECAL J i t�I� <br /> ?; <br /> I certify that under penalty of perjury under the taros o1 the Stutn of California that the Intor mann KmWed above Is true and correct.In ad"on,I on aw m that falsification 0 <br /> this brforomflon may result In suapmml on,revaoatinn,or dardaI of ranmwai of the Waste Tire Hauler"Istraeon purswmt to Pubft Resources Code section 47880 and may <br /> result in civil pmaltles up to 326,008 par day,per violation of adminlstrativato$6,000 Per violation per day as dascrIlted In PuUIlo Resources Coda section 41802 <br /> DRIVER NAME D NATU DATE y zwAwle <br /> CUSTOMEP VEHICLE IN FORIMATION <br /> MAIC / TRUCKITRAILER# LICENSE STATE O5OME7EWKUB <br /> SPECIAL tNSTRUCTiONS ! ON OFF <br /> QTY N OF WORK COAApLOW QTY. O v: DESCRIPTION OF WORK COMPLETED <br /> 1 ERVICE CALL MOUNT 1 DISMO (S)O VEHIC BRASS VALVE STEM(S) <br /> FLEET INSPECTION ALUMINUM STEM(S) <br /> AIR SERVICE LOOSE MOUNTS) 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) O RING(S) <br /> sr LIC INS TALLED <br /> QTY SIZEAdFt3 DE FINISH MILLS: <br /> �+ <br /> 4,10 START MILES: <br /> ,✓ ® TOTAL MILES: <br /> START TIME: ! 3 d AM <br /> ON SITE TIM-.- -AAA PM <br /> OUT TIME: 3 AM tea <br /> FINISH TIME: o AM <br /> LOAD AMOUNT HAULER EXEMPTION IF APPLICABLE _. <br /> © ^ LLL GOVERNMENT ❑LEA EXEMPT ❑OTHER <br /> AGRICULTURE ❑COMMON CARRIEWBACK HAUL <br /> Urri-CK UPLOAD TYPE T_ <br /> L3 IMPORT FROM / 3y - - <br /> ❑DELIVERY <br /> ' .�� W-WHOLE TIRE COUNT ❑WEIGHT IN POUNDS <br /> }-EXPORT TO .2113. (� ❑VOLUME CUBIC YARDS ❑WEIGHT IN TONS <br /> 1 certndth <br /> certify that Under penalty of perjury under the laws of the State of Cafilontla that tin Infwruafion provided above ifl b uo and correct.In addition,l <br /> oc�c Dom! an aware that felaNtcation of thts Irdorntailon may result in ctvn penaWes up 889,800 per day.per violation or adminis a tvo penalties up to <br /> t,8,0Q0 perviolaton perdayas described in Pubft Resources Code soca lan 42902. <br /> CUSTOMER PRINT NME CUSTOMER SIGNATURE DATE <br /> FSR Na. 1 '1 7 q 7 n PLEASE CIRCLE STORE LOCATION AT TOP <br />