Laserfiche WebLink
1-209-242-3051 14:14:16 07-11-2013 29/33 <br /> f , WILSON V W TIRE CO., INC. rLEET SERVICE RECORD <br /> U.S. TIRE SALES TPID 1000837. 165227 <br /> 71 Wilson Way Tire Wilson Way Tire Recap 1102 Connell Tire 421 US Tire Sales 423 US Tire Sales 424 US Tire Sales <br /> 11 N. Wilson Way 1535 Market St. 2211 N.Wilson Way 2600 Yosemite Blvd, 1915 National Ave. 6530 Franklin Blvd. <br /> tockton,CA 95205 Stockton,CA 95205 Stockton,CA 95205 Modesto,CA 95354 Hayward,CA 94545 Sacramento,CA 95823 <br /> )9-465.0281 - 209-465-3262 209-466.2581 209-571-5611 510-887.1282 916.395-2245 <br /> JSTOMER P.O.# DATE / <br /> PHONE VEH CLE 4 <br /> Az <br /> 9 <br /> LICEN <br /> rx , <br /> � <br /> )CAT OF S VICE � STA ` � ZIP CODE <br /> I�I <br /> CUSTOMER TPID /� " r�. - _ 1, DECAL �. .'. <br /> I certify that under penalty of perjury under the laws of the Slate of California that the Information provided above Is true and correct In <br /> 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 sactlon 42960 and may <br /> result In civil enallles up to$25,000 per day,per violation of administrative penalties up to$5,000 per vioistion per day as described In Public Resources Code section 42962. <br /> ZIVER NAMVA , 1 P DRIVER SIGNATURE DATE <br /> `!`IL v X <br /> CUSTOMER •- • <br /> 4KE TRUCKJTRAILER 4 LICENSE STATE ODOMETER/HLI <br /> yy SPECIAL INSTF�1jG°tlli ; , ' ` UN OFF <br /> .. <br /> QTY. DESCRIPTION OF-IWC RK COMPLETER `.Q71r.` DESCAIP7701 O)�WORI*:0OMPi.ETED. QTY DESCRIPTION OF WORK COMPLETE4 <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 METAL VALVE CAP(S) <br /> WHEEL SWITCH(S) RECONDITIONED WHEEL(S) 0 RING(S) <br /> •• /CT INSTALLED <br /> DESC�iIT1QlV FINISH MILES: <br /> START MILES: <br /> TOTAL MILES: <br /> • START TIME: pM <br /> ON SITE TIME: AM PM <br /> L <br /> OUT TIME Ant PM <br /> FINISH TIME: PM <br /> CAD AMOUNT HAULER EXEMPTION IF APPLICABLE <br /> ❑GOVERNMENT ❑ LEA EXEMPT ❑OTHER <br /> ❑AGRICULTURE ❑ COMMON C RRIER/BAV HAUL <br /> ICK UP LOAD PE <br /> ❑ IMPORT FROM HOLE TIRE COUNT UkVfEIGHT IN POUNDS <br /> DELIVERY <br /> ❑ EXPORT TO C ty--, (� ❑VOLUME CUBIC YARDS ❑WEIGHT IN TONS <br /> c Dvto I cert that n r penalty of perjury under the laws of the State of Callfamla that the Information provided above Is true and correct.In addition,I <br /> Som A am th t Islficatlon of this Information may result In civil penalties up$25,000 par day, per violation or administrative penalties up to <br /> $5,00 ervl lat on par day as described In Public Resources Code section 42982. <br /> I y <br /> CUSTOME R T N E CUSTOMER SIGNATURE DATE <br /> Rerelved T me_Jul, � 1. 2013 2 . 02PM No. (1] 93ECIRCLESTORELOCATIONaTTno <br />