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FLEF RVICE RECORD <br /> WILSON Vv_Y TIRE CO., INC- TPIu 1000837, 1.7�—ll�� <br /> ` I i,� WILSON WAY TIRE CO., INC. FLEET SERVICE RECORD <br /> U.S. TIRE SALES TPID 1000837• l7 x.511 <br /> mi) Tim Rnoyt 1-07 Connell Tire 1x21 US Tiro Sales 023 US Tire Sales #24 U <br /> % 1t '..-,{�'.�� t .5 Ara,Aer if slat <br /> ' 72fi N.Ivtlson Way 2fn0 Yo�cnuta Blvd. 1D16 NationalAve. 6530 Blvd. <br /> SwCAro:r.C-1 952,15 S(eckfon,CA 95205 Modns(o.CA 95354 Hayward,CA 94,145 Sacraf. CA 05821 <br /> :119.465-9267 209-466-2581 209571.5011 510-887.1282 916.39----j <br /> DATE <br /> PHONE VEHICLE# (// o <br /> I <br /> LICENSE# <br /> o0 <br /> AT!♦0�SERt"c� <br /> STATE / Zrj IP CODE <br /> 0 <br /> COSTONIER T FID 1 1 i I I <br /> DECAL It <br /> cr-.t I^Jl under penairy or perjury under the laws of the State of California that the Information provided above Is true and cornett.In addition,1 am aware that f on a1 <br /> '�rnaGen may result In suspension,revocation,or denial of renewal of the Waste Tire Hauler Registration pursuant to Public Resources Codo aeetton 429 all <br /> in i.,'p-values up to$25.000 por day,per violation of administralive penalties up to$5,000 perylolatlon per day as described In Public Resources Codes 42962. <br /> �DV/RIVE//RSIQ AT ARE//� 1ppT <br /> r o <br /> TRUCKrTRAILER p LICENSE STATE ODO A-UB <br /> __- _SPECIAL INSTRUCTIONS —_ — , ON OF <br /> 0 <br /> _ ^=WO,4KCOIAPLETED 07Y. DESCPJP77ONOFWORK COMPLETED -CITY, DESCRIPTION OF W( COMPLETED <br /> -- -- MOUNT!DISMOUNT(S)ON VEHICLE BRASS VALVE STEM(S) <br /> 7:7--- '-_ MOUNT/DISMOUNT(S)LOOSE ALUMINUM STEM(S) <br /> LOOSE MOUNT(S) VALVE STEM REBUILD(S) <br /> ---?- LOOSE DISMOUNT(S)O ALLIGATOR CAP(S) <br /> TIRE(S)BALANCED METAL VALVE CAP(S) <br /> --- ' " RECONDITIONED WHEEL(S) 1 0 RING(S) <br /> 'rr r <br /> -- -..._-- - ---- MFG Grr,'D�$ 1.. fy Ai^•' FINISH MILES. <br /> --------------.—_.__ START MILES. <br /> TOTAL MILES: <br /> - - - - START TIME <br /> ON SITE TIME;_ <br /> _._ OUT TIME. <br /> FINISH TIME. <br /> 'dl`w LILE <br /> r..! r'�Id.trttt U LEA EXEMPT -- _ --- <br /> a ❑OTHER <br /> COMMON RI ACK HAUL <br /> --------- <br /> HOLE TIRE COUNT JVVEIt:HT IN POUNP� <br /> VOLUME CUBIC YARDS !J WEIGHT IN TCNS <br /> ,, •,+I�r)t�urwlfetr Ittf(#rMlctd'R>1�1�!�Ie+AF Mf � _.,__.____.__-- ---. <br /> 7� of this 411r,rP466" HrtalmatMn picrvid•d rzlov Ir;true and c,rrar-t in a.l.l <br /> :a411Klcr434dtn0yl�jp tip dill. fp+virylrtion or ndministr3tive penalre, <br /> moa. <br /> , J <br /> A K$likWR! DATt <br />