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Oct 26 11 05: 49a Joe 9&hesotti Co 20998?`'464 p. 2 <br /> w� r _ nLEET:SERV�CE:RECORD <br /> : <br /> lV/JLSONs: DIY TIRE CSNC. <br /> U-S- TfRf SATES . TPID 1000837• �. 6 <br /> �': #23 U5 TJre Saes #24 US Tire Sales <br /> 2 Connell.77, #21.US Tire'Sales 6530:FranTdln Blvd- . <br /> tMlson.Wa Tire Recap 2600 Yosemite Blvd. 1915 NationalAJe. ' <br /> 101 Willson Way Tire. y 2211.N.Wilson Way;:: Hayward,.CA.94545 Sacramento;:CA 95823 <br /> t21 W 10fisdn INay' ' 7535 Nlaefcet`SC. • , <br /> Stocktbn;:CA 95205 Sfocktan;'CA 95205. Modes4o;CA 22.45 <br /> Stocl(tofi,:Cl195205 :209 466=2581=< :'`{ . 2D9-S71=561,195354' <br /> 209=465-0281. - <br /> ..209-465-320- ' <br /> DAT <br /> vow887-1282 <br /> 916=395 <br /> :;UST MER " <br /> RHONE VEHICLE 4P <br /> LICENSEV <br /> -.ZIP CODE <br /> r, <br /> LOCAT ON: F SERVICE <br /> r. —,- DECAL#• <br /> -r _ I : <br /> CUSTOMER TPID -G 101 <br /> ofte ewaLofthe Waste•Tlre HauleFRegisttatlon pursuant to F!c bbed tri Public Resources Code section.42962.. <br /> {cern thaf under penalty of <br /> perjury-under the taws of thea tate.of California:that the.Info Ices Haul provided above is true and,eortact.In addition;I am-awarectj6n Oat falsification of•" <br /> .this Information certify <br /> may result lnisuspension revocation o.. DATE <br /> result Weivil penalties uP:td525,000 0rday;per violation.DUO mm'istrative.penalties up to$5;000'per vlolatlon per•dayasides ri , <br /> DRIVER SIU LIRE 1 , <br /> DRIVER ME = <br /> LICENSE STATE ODOMETERfHUB <br /> MAKE TRUCKFrRAILER# l <br /> BRASS. LVE STEM(SZ <br /> SERVICE CALL MOUNT.]DISMOUNT(S)ON VEHICLE <br /> FLEET INSPECTION '.MOUNT/DISMOUNT(S)LOOSE <br /> ALUMINUM STEM(S) <br /> LOOSE MOUNT(S) ,VALVE STEM REBUILD(S) <br /> AIR SERVICE ALLIGATOR CAP(S) <br /> FLAT REPAIR(S) LOOSE DISMOUNT(S) <br /> TIRE(S)BALANCED METALVALVE CAP(S) <br /> REPAIR MATERIAL(S) O RING(S) <br /> •' RECONDITIONED WHEEL(S). <br /> WHEEL SWITCH(S) .. <br /> FINISH MIL <br /> START-MILES!' <br /> TOTAL MILES: <br /> START.TIME: AM PM <br /> ON SITE TIME!— AM PM <br /> OUTTIME:^ AM PM <br /> FINISH TIME: Z. M <br /> EJOTHER <br /> LOAD AMOUNTGOVERNMENT D <br /> LEA.EXEMPT <br /> O r <br /> in A, "D;COM.MON GARRIERlBAGK HAUL °r�trt <br /> PICKUP47 WHOLE.TIRE COUNT O WEIGHT IN POUNDS <br /> L] IMPORT FROM- <br /> DEL IVERY n n-VOLUME CUBIC YARDS Q WEIGHT IN TONS.' <br /> i . El EXPORT.TO ,.: i I `. In <br /> I certify that under penalty of perjury underlhe laws I State of California-that the Iriforper day, <br /> provided erviolationV ors dministativeepenalties�tur <br /> r`d tioio.Pr am aware that falsification.of.this information may it In civil penalties up•$25,000 per da ,Pe <br /> $5,000 per.vio{ation per day as dAscribed in Public Resources Code section 42962. <br /> •• CUSTOMER SIGNATURE DP`7E,. <br /> Received Time Oct, 26, JQ011R 7:'550-No, 2428 <br />