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FLEET SERVICE RECORD <br /> WILSON WAY TIRE CO., INC. TPID 1000837. 7 13 6 <br /> U.S. TIRE SALES <br /> 023 US 71ra Sales 1124 US Pro Sales <br /> I 1121 US ilr°Sales 6530 Fnnklln Blvd. <br /> I 1915 NallonA,Ave. CA 9582)— <br /> R-d<nn Woy Ttn.Rnr•nP 2211CK LYlf+on Way 2600 Yosrmlfr Ell'd. Nayvard.CA 94'x15 Sacramento. tllrrl+�"--LL��JJ„ i8 <br /> x575 MprAr1 SG Modosfo,CA 95754 916.795-7245 <br /> '. _I.+ 11-•+�r"'1t'� Srockron,CA 95205 510887-1282 <br /> R•,• l_1,t.-,••, Sh+.-Ann,CA 95705 209-5715611 - <br /> y -• :U9-465-126: ]09-d6f 7.501 DATE <br /> h <br /> I VEHICLE 4 <br /> LICENSE If 3 yJ 6,�!! ,^-.i <br /> yr ZIPrAj <br /> t STATE / )C <br /> i.\ <br /> - <br /> y <br /> DECAL N -0 <br /> I USTONIER TPID -' / ! r- _ o <br /> ` ^ r I am aware thet 60 and o'-Y°� <br /> t under the lows of the State of Callforn o that the InfonnaHauler Ra91st elion provided ll°^Vurauanl to Pu611c R�—rctis Code <br /> esouraeftCode section 42962.�J <br /> 1!•at U^•1rr°rnlin of P rj ry — <br /> •-:Inlcmat!o^may result In suspension•revocation,or denial of ranewol of the Wase Ti o DATE <br /> rasr�lt clvrl P,-?t s up to 325,000 per day.Per violation of adminlslnllve penalties up t QURROE, <br /> per vi latlon per day es described In Pu e <br /> DRIVE SIGN ( f r`. - <br /> »v / t L � _.I V �- <br /> /. 13x- <br /> - . 101 e <br /> - • <br /> STATE ODOMETEWHUB <br /> TRUCK/TRAILER 0 LICENSE <br /> ON OFO' - <br /> _ff S ECIAL INSTRUCTIONS.. - ---------- ._ _ <br /> r <br /> F7 `I OF WORK COMPLETEO QTY- DESCRIPTION OF WORK COMPLETED OTY DESCRIPTION O O <br /> CAL � MOUNT!DISMOUNT(S)ON VEHICLE BRASS VALVE TEM(S) <br /> z =vi CE_ MOUNT!DISMOUNT(S)LOOSE ALUMINUM STEM(S) <br /> C ,�N VALVE STEM REBUILD(S) <br /> LOOSE MOUNT(S) _ <br /> _ _ - LOOSEDISMOUNT(S) ALLIGATOR CAPS) <br /> CED <br /> METAL VALVE GAP(S) <br /> REE. WHEELS) O RING(S) <br /> [013m OEM FINISH MILES: <br /> :rZF MFG : '+= WSCRIFRON <br /> iL <br /> START MILES' <br /> _ 1 i cV r f� TOTAL MILES: <br /> -_—_ START TIME: AM PM <br /> j L• <br /> -"— - ON SITE TIME: Ant PA <br /> - ----- --------- -- OUT TIME AM PM <br /> FINISH TIME Ata pk <br /> R;EXEMPTION IF APPLICABLE <br /> - GOVE"J " T- Q LEA EXEMPT ❑OTHER <br /> AGRIO COMMON CARRIER/BACK HAUL <br /> AD TYPE <br /> ti I,), :([ f 'WHOLE TIRE COUN WEIGHT IN POUNDS <br /> ,�" t � �]VOLUME CUBIC YARD, I]WEIGHT IN TONS <br /> I f�.+ttp own orwor���' Ml11M fl+1F WWI$of the Mots o1 Calitanfa thal the Inforrnallun pluvlded;tbc-0 is t-9 and correct.In addftVa <br /> y� : M 1q�Y moutl In on <br /> cNil pattion up S25,000 pef d:1y. pot vloialion or adltrnl trahvu penalties up <br /> C.txk etion 42962 <br /> a 1 r <br /> ar' ' <br /> ,,I:STpM l� 11T1 GU1lTdMeR SIGNATURE ! r DATE <br /> r <br /> w {/ SyJp <br /> • �O' rr <br /> k <br />