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Feb-14-2014 10:13 AM Medline Indu=_'- = Inc 2098583272 2r3 <br /> II <br /> 05-FEB--2014 11.:33 From: . 2095551212 To:e583272 Paee:1/2 <br /> i <br /> WILSON WAY TIRE CO., INC, FLEET SERVICE RECORD <br /> U.S. TIRE SALES <br /> IND 1000837, 17 12 0 6 <br /> "I W 14on Woy T7ry Wilson Way 1 rn ROOap #02 Connell 77m 9129 US 77re Set" r#26 U9 77ro Ce/ea 024 U9 rim 9ala3 <br /> 221 N,WAson Way 1838 Mofkat St .2211 N,WR9on Vrrky 2000 Yd"w,'fo Blvd. 1015 Notlon2fAm 6530 Frankiln Blvd, <br /> Stockton,CA 05205 Tiovkrvn,CA 95209 Stockton,CA 96269 Modukto,CA 06354 Hayward,CA"CJS skenmenta,CA 9S?23 <br /> 209-465.0281 zcs•ast�a282 soa�ac•ase� �oa•e7�•sea� siaser.yae2 als�as rias <br /> GUST MEPo C,O.A DATE <br /> PHONE VEHIOLEII L <br /> f, <br /> LIdEN$l:� <br /> LOCA ON OF AFAVICri <br /> STATE 21P CODE <br /> j <br /> CUSTOMEPt TPID — DECAL# — <br /> I certIfV that under ponalty of perjury under the taw;,'of the 51ate oraallfamia that information provided ebove Is tete and correct,In addltlon,I am amara thatfM*(1R atlon of <br /> thio infvrmatlon may noull In nue onilon,rovo¢atlon,or dunlal of rvnowal or lhoivaa2o'rire WoulpT R•Q tutmtron pursuant to PUbUo Rasouraa&Code aealion 12960 an m <br /> r"ult In elvll pendtlnk up to$28,050 per dry,ger vlolWon of odminUtrotNo,panaltlnr,up to 46,000•par vlolotfon'per dray-no deeorlbod In Publla Raocurvee Code ov*von 4ZIJ 2. <br /> DRIVt'RpyRIVSR BIONATU DATZ <br /> A <br /> MAKETRUCWTRAILER 00 UICENSE STATE ODOMLTPR/H119 <br /> ISM- <br /> r S <br /> 292AM 1,101 ,'0 <br /> SERVICE CALL MOUNT/DISMOUNTS)ON VEHICLE BRASS VALVE STEM($) <br /> FLEET INSPECTION MOUNT/DISMOUNT(S)LOOSE ALUMINUM STEM(G) <br /> AIR SERVICE LOOSE MOUNTS) VALVE STEM REBUILD(G) <br /> FLAT REPAIR(S) LOOSE DISMOUNT(S) ALLIGATOR CAP(') <br /> REFAiR MATERIALS) TIRE(0)SALANOED METAL VALVE OAP(S) <br /> WHELL SWITPH(S) RECONOITIONED WHEEL(S) 0 RING(9) <br /> y FINI6H MILES',— ' <br /> . <br /> ` .START VII R5` <br /> TOTAL MILES: au <br /> U00 5L� START TIME: AMS <br /> ON SITE TIME: AM PM <br /> OUT TIME: AM PM <br /> FINISH TIMFr r AM nP <br /> LOAD AMOUNT <br /> L]GOVERNMENT Q LEA EXEMPT O OTHER <br /> ——— — ❑AGRICULTURE COMMON CARRIERIBACK HAUL <br /> PIC 0 IMPORT FROM ` WHOLE TIRE COUNT Q WEI©H-r IN POUNDS <br /> 11 0 FRY VOLUME CUBIC YARDS �]WEIGHT IN TONS <br /> ❑ 1:7CPpRT 70 <br /> o�c Dvfq�� l ao tlty that undor ponalty of pnq undot thn 1 c of aha 5tato of Callfornla tyot tho Intermotlen provi cad obovo to truo and oorroaL In odditlon 1 <br /> om owaro that falffIncatHon of thl:Information y result In dull ponaltle:up$25,400 pot day,per vtolatlon v7 adminlstratlYe p9r101119s uy(o <br /> $5,000parvlolationpordoyor.dascribad4nPubltc esouresoCo4oE9ot1on42962 <br /> CUSTOMER PRINT NAM? CUSTOMER SIONATURE DATE <br /> �Recei•ved Time1F_b, 14. 2014r<110: 19AM�Lr_k09 Qr6AROLESTORE LOCATION ATTOP ;'-_ <br />