Laserfiche WebLink
�J WILSON WAY TIRE CO., INC. FLEET SERVICE RECORD <br /> U.S. TIRE SALES <br /> TPID 1000837. 82801 <br /> #01 Aeon Way fire Wilson Way Tire Recap #02 Connell T"rre #a5-Wilson Way Tim #21 US Tire Sales #23 US Tire Sates #24 US Tire Sales <br /> 221 N.Wlfson Way 1535!Market 5t. 2211 N.Wilson Way f 133 W.llevemth St. 110W Y.-91.•tvd. 191 S Nationaf Ave. 6530 Fronkttn 91v&Stockton,Ca.95205 Stockton,Co.95205 Stockton,Ca.93204 Tracy,Ca.95376 Modesto,CA.95354 Hayward,Ce.94545 Sacramento,CA.95823 <br /> 2p9.495-02Bt 2065-3262 2094662581 2094354097 209,571.5611 510.997.12D2 916,795-2245 <br /> P.O. # DATE <br /> 23� PHONE VEHICLE # <br /> LICENSE# O <br /> LOCATION OF SERVICIE TATE ZIP COD <br /> CUSTOMER TPID 0 DECAL t <br /> I 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,1 am aware that falsification of <br /> Phis Information may result In suspension,revocation,or dental of renewal of the Waste Tire Hauler Registration pursuant to Public Resources Code aection 42960 and may <br /> 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. <br /> DRIVER NAM �� X IVER SIGJC) RE DATE <br /> CUSTOMER D <br /> MAKE TRUCK/TRAILER# LICENSE STATE ODOMETER/MUB <br /> _ SPECIAL INSTRUCTIONS _ ON OFF <br /> QTY. I DESCRIPTION OF WORK COMPLETED QTY DESCRIPTION OF WORK COMPLETED OTY. DESCRIPTION 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 MATFRIAL(S) TIRE(S)BALANCED METAL VALVE CAP(S) <br /> WHEEL SWITCH(S) RECONDITIONED WHEEL(S) O RING(S) <br /> OTY SIZE MFG DESCHIPTION FINISH MILES. <br /> START MILES. <br /> TOIAL MILES: <br /> START TIME AM PM <br /> ON SITE TIME AM PM <br /> OUT TIME AM PM <br /> FINISH TIME AM PM <br /> LOAD AMOUNT •� HAULER EXEMPTION IF APPLICABLE <br /> ❑ GOVERNMENT El LEA EXEMPT ❑ OTHER <br /> ❑AGRICULTURE ❑ COMMON CARRIER/BACK HAUL <br /> PICK UPIf LLA I <br /> LOAD TYPE <br /> ❑ INIPORT FROM HOLE TIRE COUNT FJ WEIGHT IN POUNDS <br /> ❑ DELIVERY _— - <br /> D EXPORT 70 (S VOLUME CUBIC YARDS [D WEIGHT IN TONS <br /> I 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 <br /> odc Doto` am aware that falsification of this information may result In civil penalties up to$25,000 per day,per violation or adminicirativ.penalties up to <br /> a $5,000 par violation per day as described in Public Resources Code section 42962. <br /> CUSTOMER PRINT NAME CUSTOMER SIGNATURE DATE <br /> FSR No. R?R n i <br /> nt ceoc nrnr„ <br /> 2'd 262889b:01 SSt'12-19b�(602) I 0-1 08I1 A.Uh1 N080Ir-14W0ad GS:z0 S002-Sl-tAnf <br />