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- ® WORK ORDER' <br /> 1274877 <br /> Waste Tire Hauler <br /> Waste Tire Generator <br /> } I'll�k Tire Service Center, Inc. Na <br /> 1407 Lone Palm Ave. mc <br /> Modesto, CA 95351 <br /> _ 209-521-6221 <br /> City "-')tato <br /> TPID-1274877-01 zip Phony: <br /> Date, TPID with Sutflx <br /> 30='# - Load Type: [ ]Wholrj [ I Cuhic Y,ucf [ ]Ion I ] P01,11 j <br /> ense <br /> state: Dot Code: RWDY ]Pick-up Count: <br /> I <br /> REC'ULAR TIME ( ] OVERTIME [ ] CALL OUT CUSTOMER POtI <br /> --\ REPAIRS <br /> -- WHEEL SWITCHES MT/DISMT <br /> -NSE NO. <br /> VEHICLE MAKE-_ MILEAGEVEHICLE NO <br /> -'OCATION: <br /> ' ARK PERFORMED: <br /> MILEAGE. IN <br /> MILEAGE OUT <br /> TOTAL <br /> 1 <br /> i <br /> TIME IN <br /> TIME OUT 1 <br /> SIZE MFG. DOT# TREAD WHEL[_ COMMENTS <br /> 1 <br /> 1 <br /> TrjRGUE LUG NUTS AFTER 50 TO 100 MILES --- NOT RESPONSIBLE FOR GOODS LEFT OVER 30 DAYS <br /> Date: Customer Signature: Date <br /> ,r- IlarnN (print) Customer Name (print) <br /> eil A r oI under the leve of the state of uwomia that tho Inlorrnation I'101MY that uud.r p.nalty of{sunµuY under lh»lawa of Vlv atat.of caaTan.a that tlw ateivnw:k•. <br /> '' •'� 'E'""' W'i Y 1 ern aware Ilial IaUiru;alion of this intonnetlrm nlay ilrovidod abov.16 t1wo and C1NIei 1 III ad(Iltictll,I ant awatl lflA11d1A 6,'.raK/ !t7ws.nhvnwtn>n mar <br /> aw�cne In,e wo wre'l In adrltluxl, <br /> rr denial of renewal of the Wasis Tire Hauler Registration puMMI'll rouldl clvtl penaltiaa up to$2S,000 pelr day.{ror alcaatx>tr cv ocin.x�+�tr�ilv»{wnsNms,qI to 55.ekK <br /> :� ✓.:.v'.a r,�rie nsl <br /> 29 am ma result In civil fx <br /> AaUipn 4up to 15.000 pairUes up lu$25,000�or day, par vlolaunn Igen(Jay nn daacnhxd m V'uhil�:r1.su�ur�o l:c„fo sec i„uI 6.136: <br /> y violation per day as described In I uhlic,, <br /> I'//Yr:�✓,%'.r 47!!1. <br /> waste lire Dehvery Point <br /> )011very Count: _ _ — Date ( ]Same As Hauler <br /> p.p Waste Tire Delivery Point Waste Tife Delivery Point <br /> ( J McCoy Truck Tire Service Center ( 1 McCoy Truck Tire Service Center <br /> r7, y CfG�ER/MANIFEST 10850 Harlan Rd. 1537 E. Market St. <br /> 1, �""B French Camp, Ca.95231 Stockton, Ca. 95205 <br /> 4877-,5 `°� 0 TPID#1352986-01 Phone 209-982-0115 TPID#1778978-01 Phone 209-652-0434 <br />