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i <br /> i <br /> WILSON WAY TIRE CO. INC. FLEET SERVICE RECORD <br /> U.S. TIRE SALES TPID 1000837• 7a_ <br /> 023 US Tiro Sales 1124 US Tire Sales <br /> T•.•Rrc,p P02 Cnnnrfi rim #21 US Tiro Safes 1915 Neflonal A— 6590 Franklin aNd. <br /> Sf 2211 fl.IY,Icnn Way 2600 yasamfru Blvd. Sacramento,CA 95822 i8 <br /> C-1 45;P. tie:Asan.CA 95205 Str,O mn,CA 95705 Modasfo,CA 95354 Hayward.CA 94545 <br /> ti:9JS1111•E/ :d9 If,5J:62 209-466-2_5,91 209-571-5G 11 <br /> 510-887-1282 918-395-22AS — <br /> --------- —— - DATE <br /> PHONE VEHICLE# <br /> -- - - - -- - - -- LICENSE# <br /> STATE CODE <br /> CUSTOMER TPID .. - i , — DECAL# ��� <br /> I re tfy tn.+t u.*dar Frnaitp of perjury under the laws of tho Slate of California that the Information provided above Is true and cornet In additlon,1 am aware that 1a1a11/; 1 01 <br /> ft�i,nf.rrnat:on may result in suspen,lon,rCvocafor,or donlal of renewal of the Waste Tire Haule LReglstrallon pursuant to Publle Resources Code section 42860 a�� <br /> I! ac.�it•rt civil p—,IV-up to$25,000 per day,per violation of edminletrative penalties up to 5,0 6 peT loloon per day as described in Public Resources Coda section 42862. <br /> DRIVER SSG F y D1jT + <br /> CUSTOMER •- • <br /> " <br /> TRUCKffRAILER# LICENSE STATE ODOMET <br /> SPECIAL INSTRUCTIONS ON OFF <br /> P" /;,Ii <br /> ^E SGR.rPRGtc OF WORK K COMPLETED QTY DESCRIPTION OF WORK COMPLETED J QTY I DESCRIPTION OF WOR o LET ED <br /> SERVICE CALL MOUNT/DISMOUNT(S)ON VEHICLE BRASS VALVE STEM(S) <br /> F!=E—I INSPECTION MOUNT/DISMOUNT(S)LOOSE ALUMINUM STEM(S) ;pl <br /> ':P 5ER%10E LOOSE MOUNT(S) VALVE STEM REBUILD(S) <br /> =-%,T REPAIRiS� LOOSE DISMOUNT(S) ALLIGATOR CAP(S) <br /> PcrP.IR;'ATERi�._ S, TIRE(S)BALANCED METAL VALVE CAP(3) <br /> :sEEL S YtTC :'S; RECONDITIONED WHEEL(S) O RING(S) <br /> ..ODrr <br /> -� FINISH MILES <br /> SIIF MFG :.'./JESCR/PTJOJur;`�:''_:�: <br /> i <br /> START MILES: <br /> TOTAL MILES: <br /> START TIME: AM Pig <br /> -.-------------._.__-- ---.-__-.--- _ ON SITE TIME: AM P1 <br /> - ----- ------ -- OUT TIME'. >:! PI <br /> FINISH TIME' AM P <br /> :A-0 AMOUNT �/1PTION IF APPLICABLE j <br /> c I— GOVERNMENT Q I,EAVEMOT (]OTHER <br /> AGRICl1LTURQgM�4�:CARRIER/BACK HAUL <br /> - ,• t r, t <br /> D TYPE. <br /> HOLE TIRE COUNT IJ LVEIGFIT IN POUND; <br /> Iry ❑VOLUME CUBIC YARDS <br /> WEIGHT IN TONS <br /> Hr1Ny th;si urldQf p 900rft�iy�'�ON 61{6W Of Cglifornta that the Informntlnn Pf(IV Ided above i,,Iruo and�ortect.In adf <br /> " ' a"e'iw°fast f,M*ll1� 11Nbi,t#Iiftll In etyll penalties up 325,000 per day. Pet vIolal!t:n or adrnlniatrauve pana!Gt t <br /> i5. pe►�vfMaUahplaf lJklP'ANhJds <br /> �oYM�Cae*cGon42A82. <br /> )Mfv t�it1PIT CUSTOMER SIGNATURE: QkTE <br />