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-- 1 <br /> �� m0b- WILS WAY TIRE CO., INC. EET SERVICE RECORD j <br /> 11R TIFF.Cdl F.0 <br /> r`' elft�trtl WILSON WAY TIRE CO., INC. FLEET SERVICE RECORD <br /> ";_'- U.S. TIRE SALES <br /> TPID 1000837 17 4 6 7 5 <br /> �rtti <br /> a0r tYAa°^tyai.Yir�` i'yrhon Way Tire Resp F07 Cannell Tira dZi US Tiro Sales 823 US Tlra Sal9s .124 US 7 <br /> �j';,,, :71 i' Wilson Way 1575 Af.vkof Sr, <br /> 7211 N.Wilson Way 2600 Yosemite Blvd. 1915 National Ave. 6530 Fnr d, <br /> ` St—At-1.CA 95h�5 Stockton,CA 95205 Stockton,CA 95205 Modesto,CA 95350 Hayward,CA 94545 Sacnmo 9692 <br /> 209 465-7267 209-466-2561 209-571-5611 510.887.1182 010-395- C2 <br /> P.O.d DATE <br /> PHONE VEHICLE 01 <br /> ----- --._--- — --- ---- LICENSE <br /> D iv �Y k-� OO <br /> ! LOCAT,o%OF SERVICE <br /> STATE CODE <br /> X. <br /> CUSTOMER TPID L� - DECALq <br /> 'certy that under penalty of perjury under the laws of the State of Callfomla that the Informatlon provided above Is true and correct,In addition,I am aware that fat irl n of <br /> t�:s:nrormation may resuft in suspenslon,revocallon,or denial of renewal of the Waste Tire Hauler Registration pursuant to Public Resources Code twetlon 42900 -Ir 29 <br /> esul:i❑civil penalties up to$25,000 per day,per violation of administrative penalties up to$5,0Oq er violation per day as described In Public Resources Code seen :g-61. <br /> DyRIVE S�GNAT �E !' DTE// <br /> . a a <br /> ` = TRUCKlTRAILER# - LICENSE STATE —Tbq_C3 <br /> SPECIAL INSTRUCTIONS <br /> pN <br /> FF�- <br /> 0 <br /> CESCR'P77Oh`OrWORK COMPLETED' QTY"•+ ii,,.:btSCRIPTION OF WORK COMPLETED QTY. DESCRIPTION OF WORK COMPLETED <br /> C..ALL MOUNT DISMOUNTS)ON VEHICLE BRASS VALVE STEM(S) <br /> IF <br /> -_E INSPECTION MOUNT/DISMOUNT(S)LOOSE ALUMINUM STEM(S) <br /> =1 =RVIICE LOOSE MOUNT(S) VALVE STEM REBUILD(S) <br /> =-'T PEPAIR,S) LOQSE DISMOUNT(S) ALLIGATOR CAP(S), <br /> TIRES)BALANCED METAL VALVE CAP(S) <br /> C rS1 RECONDITIONED WHEEL(S) O RING(S) <br /> -�a <br /> ( ) <br /> S+ZS I MFG'-,A! 1. �•�, �. � � �.,�o..vl.{.._ FINISH MILES. <br /> -------- i -- START MILES <br /> --f-------- — ! I TOTAL MILES <br /> ----- -- -- -- �` START TIME. a\i Ptt <br /> ON SITE TIME: Atit PI,1 <br /> OUT TIME <br /> Ahl Pf.1 <br /> — - --- --------"--- FINISH TIME <br /> )irJ{EMPTIONIFAPPLICABLE <br /> _J G0t/ERNMEtVT U LEAxEMPT <br /> — - - - - <br /> - <br /> O OTHERAG�ICULTUR6C6MMON CARRIER/BACK <br /> HAUL <br /> i <br /> A� AI�'rypE <br /> �..... f 1`VVHOLE TIRE COUNT J WEIGHT IN POUNDS <br /> VOLUME CUBIC YARDS (J VVEIG IT IN TONS <br /> e a' " 'iM6ally 4�F I*"at me 5116%of CaliforMa that the information provided ahavo IS <br /> OW♦a s sfv�aaNl;,�liyn p/. W 1011110"hi.CIVO ponattla►uerp 125,000 pJn <br /> 1,.. �'' 1I'P,•.c'e,t$t►yly �I�M�{t1�M011►tF�llCvdxsac11on42BN7. Yp <br /> . •r Into anrt r.ont:r_t In iddih:n <br /> .fui,tgvn �t at_Ln101sltativn p9nattres rtp�. <br /> : .'{ NAME CU310MER JIGNATIIRF. DATE <br />