Laserfiche WebLink
(WE) <br /> WILSON WAY TIRE CO., INC. FLEET SERVICE RECORD q0l <br /> U.S. TIRE SALES <br /> TPID 1000837- 161485 <br /> Alsori Way Tire Wilson Way 77ro Recap 402 Connell T7ro <br /> .Wilson Way 1535 Market St. M21 VS Tiro Sales #23 US T7ro Sales #21 US T7ro Sales <br /> TStockton,on,CA 95205 2211 N.W7ison Way 2600 Yosemite Blvd. 1915 National Ave. 6530 Franklin Blvd.n,CA 95205 <br /> 65-0281 Stockton,CA 95205 Modesto,CA 95351 <br /> 209-485-3262 209-166.2581 Naywarr�CA 91545 Sacramento,CA gs823 <br /> OMER <br /> 209 577-5611 510.887-1282 916.395.2245 <br /> O I YL�h aL P.O.# '.� -2113 DATE <br /> PHONE <br /> -,23 - (-3 <br /> VEHICLE# <br /> �3a <br /> LICENSE# <br /> TION OF ERVICE �� d <br /> STATE ZIP CODE <br /> USTOMER TPID <br /> DECAL# <br /> ertl►y that undern <br /> pe afty of perJury under the taws of the State of California that the Information provided above Is true and correct In addition,I amaware that falsification of <br /> s Informallon may result in suspenalon,revocation,or denial of renewal of the Waste Tiro Hauler Registration pursuant to Public Resources Code section 42960 and may <br /> suit In civil pens flies up to$25,000 per day,per violatlon of edministrallve penalties up to$5,000 per violation per day as described In PublIc Resources Coda sectlon 42962. <br /> 'RN E , / DRIVER SIG RE <br /> Q� �G v � DATE <br /> /� �c 4r 6 -..?3 . f3 <br /> TRUC RAILER# LICENSE STATE ODOMETE"Lla <br /> Q Al- <br /> SPECIAL INSTRUCTIONS ON O <br /> Zr L Je U OFF <br /> wr�-,v <br /> -s` S --- -- <br /> I. DESCRlPT)ON OF WbRJC COMPLETRi3 LITY. 7i IPTION OF WORK COMPLETED QTY. DESCRIPT70N OF WORK COMPLETED <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 /> WHEELSWITCH(S) RECONDITIONED WHEEL(S) ()PIN 111,11 <br /> • ra <br /> 512E FINISH MILES: <br /> aSTART MILES: ,S 7 <br /> TOTAL MILES: 3`7 <br /> START TIME. <br /> ON SITE TIME: AM PM <br /> OUTTIME: AM PM <br /> FINISH TIME: al PM <br /> to AMO T HAULER EXEMPTION IF APPLICABLE <br /> ❑GOVERNMENT ❑LEA EXEMPT ❑OTHER <br /> C)AGRICULTURE ❑COMMON CARRIER/BACK HAUL <br /> 'ICK UP LOAD TYPE <br /> ❑ IMPORT FROM <br /> 7ELIVERY `WHOLE TIRE COUNT ❑WEIGHT IN POUNDS <br /> ❑ EXPORT TO <br /> ❑VOLUME CUBIC YARDS ❑WEIGHT IN TONS <br /> Data A I certify that under penalty of perjury under the laws of the State of California that the lnfortnatlon provided above Is true and correct.In addition,I <br /> em swats that falsification of this Information may result in civil penattlas up$25,000 per day,per violation or administrativa panaltfas up to ' <br /> _ $5,000 par vlolation pa r day as described in Public Resourres Coda eactlan 42982. <br /> CUSTOMER PRINT NAME CUSTOMER SIGNATURE (DAA j <br /> R No- 161485 PLEASE CIRCLE STORE LOCATION AT TOP <br /> 9!9 17LOZ-EO-1.0 17S:FE:60 ISOE-ZVZ-60Z-L <br />