Laserfiche WebLink
WORK ORDER/MANIFEST <br /> O <br /> 1274877- 5 0 5 9 5 <br /> Waste Tire Hauler Waste Tire Generator <br /> McCoy Truck Tire Service Center, Inc. Name: <br /> 1407 Lone Palm Ave. Address: Z C r i 11� V <br /> Modesto, CA 95351 City: _ -} ���/;, f State: <br /> 209-521-6221 Zip: Phone: 7 S Ll 4 <br /> TPID-1274877-01 TPID with Suffix: r y <br /> Load Date: Load Type: [ )Whole [ ]Cubic Yard [ ]Ton [ J Pound <br /> Decal <br /> License#: I State: I Dot Code: RW DY ]Pick-up Count: ———— <br /> [ ]REGULAR TIME [ ] OVERTIME [ ]CALL OUT CUSTOMER PO# 7 6__-K&1K <br /> FLAT REPAIRS WHEEL SWITCHES MT/DISMT <br /> _ ll <br /> LICENSE NO. �''1 '.`VEHICLE MAKE MILEAGE l VEHICLE NO. ttlil �l� L/ "J <br /> LOCATION: I �- C+ ✓ f ,l 4 ►+� H L <br /> WORK PERFORMED: MILEAGE IN f <br /> 104 �..,� ��C >1t' t .��I a MILEAGE OUT L <br /> / 1� 7 <br /> t/L G v, L N 7- TOTAL <br /> to <br /> TIME IN <br /> TIME OUT 7E- A (Nl <br /> SIZE MFG. DOT# TREAD WHEEL COMMENTS <br /> ' L i'Z2 ._ , <br /> 2 v <br /> 3 tt77 <br /> 4 <br /> 5 V <br /> 6 <br /> 7 <br /> RE-TORGUE LUG NUTS AFTER 50 TO 100 MILES --- NOT RESPONSIBLE FOR GOODS LEFT OVER 30 DAYS <br /> Drivers Signature: Date: Customer Signature: . ��%G Date: t 13 !(,o <br /> Drivers Name(print) Customer Name (print) <br /> I certify that under penalty of perjury under the laws o�the State of California that the information I certify that under penalty of perjury under the laws or the State of Califomia that the infomtalion <br /> provided above is We and correct.In addition,I am aware that falsification of this information may provided above is true and correct.In addition,I am aware that fal5lftcat,on of this information may <br /> result in suspension,revocation,or denial of renewal of the Waste Tire Hauler Registration pursuant result civil penalties up to$25,000 per day,per violation or administrative penalties up to$5,000 <br /> to the Public Resource Code section 42960 and may result in cml penalties up to$25,000 per day, per violation per day as described in Public Resource Code section 42962. <br /> per violation or administrative penalties up to$5,000 per violation per day as described in Public <br /> Resource Code section 42962. <br /> [ ]Delivery Count: Date Waste Tire Delivery Point <br /> [ I Same As Hauler <br /> oarTia Waste Tire Delivery Point Waste Tire Delivery Point <br /> WORK ORDER/MANIFEST [ ]McCoy Truck Tire Service Center [ I McCoy Truck Tire Service Center <br /> 1274877- B10850 Harlan Rd. 1537 E.Market St. <br /> French Camp,Ca.95231 Stockton,Ca.95205 <br /> TPID#1352986-01 Phone 209-982-0115 TPID#1778978-01 Phone 209-652-0434 <br />