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VCHOETTLER TIR _ WORK ORDER TRUCK CENTER TRUCK CENTER 2840 E.CHURCH AVE. 808 N.GATEWAY - 22800 AVE.1812 1539 ROBERTSON BLVD. 711 E.CHILDS AVE. MADERA MGT. FRESNO,CA 93708 MADERA,CA 93631 MADERA,CA 93637 CHOWCHILLA,CA M610 MERCED,CA 95340 504 N."E'•ST. (559)2044982 (559)674.4678 (559)674-6236 (559)665-3704 (209)723-1823 MADERA,CA 93638 TRIG 41200571-01 TPID 41200603-01 TPID q 1098571-01 TPID 01099758-01 TPID p 1098633.01 HAULER(559)674-4471 TPID # 1000472-01 CUSTOMER CUSTOMER W.O.WRITER ACCT. NO. BILLED TO SHIPPED TO ADDRESS —_—__.— TPID# --- CITY/ZIP t PHONE NO. NAME P.O.NO. VEHICLE MAKE SALESMAN SERVICEMAN - --"-� DATE UNIT NO. LICENSE NO. SPEEDOMETER iiDG OFF TIRE NO. ON TIRE NO. AM TIME IN .120 PM AM TIME OUT PM —MILEAGE SERIAL NUMBERS LABOR&SERVICES EACH �� j ---- ---------� —_ — --- — AX SUB TOTAL LF RF SALES TAX i — CA STATE TIRE TAX TIRE DISPOSAL CHARGE TOTAL - -- -----___..__..---------�-- LABOR SUB TOTAL Lf TRADE-IN _—. —_ I ALLOWANCE TIRE DISPOSAL CHARGE TOTAL LABOR&SERVICES f TOTAL Pass 2.50 Lt.Irk 4.OD Med.tdr 9.00 tractor/off road vedee -_ ESTIMATE OFF TIRES=Scrapped-Returned-Recap-30 day hold �rss�Eu�ztct45tt: rtt� dug decoct dlw& 4 dec"�n Ag4eNeaa Bron 30 days.. 1 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,I am aware that falsification of 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 result in civil penalties up to$25,000 per day, per violation or administrative penalties up to$5,000 per violation per day as described in Public Resources Code section 42962. Driver's Name(print) Driver's Signature Date Whole Tire Hauler Exemption(if applicable) o-10-.. . �� Pick-up E Delivery❑ Tire Count# ❑ Import/Export State_/Country_ d e D Tons ❑ Government ❑ LEA Exempt License If Sta/tte Decal# D Pounds F1 Agriculture ❑Common Carrier/ C„ D Cubic Yards Back Haul TERMS: This is not a Revolving Credit Transaction.After the 10th of the month following the date of this Invoice(or after Indicated due date on this invoice)due to difficulty,impracticality of ascertaining expenses for negotiating,servicing•collecting and enforcing this account,N overdue,subjects it to a monthly interest charges of.833%per month(10%PER ANNUM)and an adddltionai service charge of 1.167°/,(14%PER ANNUM)for a combined monthly interest and service charge of 2%per month(24%PER ANNUM). I certify that under penalty of perjury under the laws of the State of California that the information provided above i8 tnpand correct.In addition,I am aware that falsification of this infomiatlon may result in civil penalties up to$25,000 per day,per violation or administrative penalties up to$5,000 pervlotation per day asdeacrmed in Public Resourct9£6ae-section 42962. Customer Name(print) Customer'Signature Dote WHITE-NUMERICAL FILE COPY PINK-FILE COPY CANARY-CUSTOMER COPY WHITE-CUSTOMER COPY WHITE CONTROL COPY