Laserfiche WebLink
•• •rr� 1114E GO, INC. FLEET SERVICE RECORD <br /> U.S. TIRE SALES TPID 1000837. 16 14 8 Q <br /> 1101 Wilson Way Tire Wilson Way Tire Recap 002 Connell77re 011 US 77re Sales <br /> 221 N.Wilson Way 1535 Market SL 023 US T1re Sales 024 US 77re Sales <br /> 2211 N.WAson Way 2600 Yosemite Blvd 1915 National Ave. 6530 Franklin Blvd. <br /> Stockton,CA 95205 Stockton,CA 95205 Stockton,CA 95205 Modesto,CA 95354 Na art,CA 94545 <br /> 209-455-0281 109-465-1262 209466-2581 Sacramento,CA 95823 <br /> 209-571-SQtf 51"87.1282 <br /> CUSTOMER <br /> P.Ot! 916.395-2145 <br /> . <br /> q D DA ( 1/ . (_3 .- <br /> PHONE <br /> VEHICLE <br /> ! <br /> LICENSE 0 <br /> LOCAT! ry�3F,S.ER1(ICE � <br /> 9" STATE <br /> ZIP CODE <br /> CUST6'Mg P � <br /> r O i,` - - �_471A - AJ]) DECAL a <br /> :histhat undai' i1w-,I y$ perjury under the laws of the State of California that the Information provided above Is true and correct.In addition,I am swore that falsification at <br /> :his Information may mull'In suspension,revocation,or dental of renewal of the Waste Tire Hauler Replatrstion pursuant to Public Resources Cods section 42960 and may <br /> result in civil penalties up to$25,11DD par day,per violation of administrative penalties UP to$5,000 per violation per day as described In Public Resources Code section 42982. <br /> DRIVER NAME DRIVE NATURE j� <br /> X Ot. vi DATE <br /> 0C j M ` <br /> 11 •19 • r J2 <br /> TRUC ILERO LICENSE STATE ODOMETERIHUB <br /> n11Q 47 7 <br /> ECTAL vclriow,c - ON OFF <br /> _B/J IIL� <br /> `- <br /> 57- <br /> L <br /> DESCRIPTION <br /> 7- <br /> DESCRIPrn3N dFvVi 606 ' 471c ESCwp, <br /> =R3N OF WORK COMPLETED Q71 !)ESCHIPTION OF WORK COMPLETED <br /> SERVICE CALL <br /> MOUNT I DISMOUNT(S)ON VEHICLE l BRASS VALVE STEM(S) <br /> FLEET INSPECTION MOUNT/DISMOUNTS <br /> ( )LOOSE ALUMINUM STEM(S) <br /> AIR SERVICE LOOSE MOUNT(S) VALVE STEM REBUII;D(S) <br /> FLAT REPAIR(S) LOOSE DISMOUNTS) 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 /> ee e <br /> QTY R1P770N FINISH MILESO ep, tJ <br /> / �Paa �7-33 <br /> 3rd S+ a? � / START MILES: <br /> TOTAL MILES: 4 <br /> 1 <br /> START TI ME: <br /> ON SITE TIME AM PM <br /> OUT TIME: A PI,I <br /> FINISH TIME f t <br /> LOAD AMOUNT HAULER EXEMPTION IF APPLICABLE <br /> AH <br /> •� CGOVERNMENT ❑LEA EXEMPT Q OTHER <br /> ❑AGRICULTURE ❑COMMON CARRIER/BACK HAUL <br /> P K UP LOAD TYPE <br /> ❑ IMPORT FROM <br /> DELIVERY WHOLE TIRE COUNT I]WEIGHT IN POUNDS <br /> ❑ EXPORT TO ❑VOLUME CUBIC YARDS 0 WEIGHT IN TONS <br /> Dara I certify that under penalty of perjury under the laws of the State 01 California that the Information provided above is true and eo .4 t.In addition,I <br /> mop r am aware that falsification of this Information may result in civil stiles up 525,000 per day,per violation�mlnlatrative penafties up to <br /> 35,0 a IalatlonperdayssdesalbedInPublic ResourceaCodee o 421]82. <br /> CUSTOMER PRINT NAME CUSTOMER SIGNATURE <br /> DATE <br /> FSR NO. 1614 8 0 PLEASE CIRCLE STORE LOCATION AT TOP <br /> 9iS 7LOE-£0-LO EE ZE:60 l50£-ZbZ-60Z-1 <br />