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Feb-14-2014 10.13 AM Medline Indus es, Inc. 2099583272 3/3 <br /> 05-FE -2014 11:34 From: . 2035551212 Tor®583272 Pa9et2o2 <br /> &� WILSON WAY TIRE CO:; INC. FLEET SERVICE RECORD (NII <br /> U.S. TIRE SALES TPID 1000837. 1712 0 7 <br /> Of IM/son MyT7ro V✓12on way Tiro ROCOP #02 Connell17ro #-21 US 7Tre safes 03 US•71ro 9atea #24 US TIYe Salsa <br /> 121 N,Wilson fty 1636 Markof at: 1911 N.Wllaon My 2660 vasamfla Blvd, 1915 National Ave, 6530 Franklin Blvd, <br /> rfocJ4tbn,CA 83205 SfooRion,CA MIME 6todktoh,P4 anas Modoato,CA 05954 Hayward,CA 94546 3adramsnto,QA 65823 <br /> IOMON-0281 209-466.3262 2a8 4B6•Z581 209371.5611 510.887-1282 91W99•9245 <br /> IUSTO ER P.O,# DATE <br /> P ONe VEHICLU 0 <br /> R LICENSE ft <br /> ILL <br /> E Vl0 STATE ZIP COD!!_ `` <br /> -M dlii� <br /> CUSTOMER TPID t Q - DECAL.# LL-1•N— <br /> 1 certitr that under penalty or pedury undar the laws of the state or Cahfomlp shat tha.lnfamijtlen provldad above to true and oerwet.Ih addition,I am aware that hlelffwUvn of <br /> I oo ermatlon max fnsuit in ouspenslont revocation,or canial•of mnami of tha•WkSte lire Hauler R8918tretton pursuant to rublIr Resources Code*9010A 42MO end may <br /> raault In civil penalties up to$22,000 per day,pee vlo%von bt edmintetratwc po.naltfea up to$S,000 per vlotation per day as dascrlbod In public Roaeureoo Ceda 000tlan 42107)RIVER WNE , <br /> DRIVER 810NAT DA <br /> x <br /> fAAKE U TRUCf1TRA� ULICENSE STATEy ODOMETERMUB <br /> >• 'w ` W7"I.0t`�.S•J,y'_'' �a •� , Si M y'- �1`�'d.Y C.P •�,.. . <br /> SERVICE GALL MOUNT!DISMOUNT($)ON VEHICLE BRASS VALVE STEM(S) <br /> FLEET INSPECTION v�iOUNT/DISMOUNT(S)LOOSE ALUMINUM STEM(S) <br /> AIR SERVICE LOOSE MOUNTS) VALVE STEM REBUILD(S) <br /> FLAT REPAIR(S) LOOSE DISMOUNT(S) ALLIGATOR CAP($) <br /> REPAIR MATERIAL(S) TIRE(S)BALANCED METAL VALVE OAP(S) <br /> WH8EL9WITOH(6) R6COtyO1TIONED WHEEL(S) 0 RING(S) <br /> 1 h - ..,ei.9 rI•* dr r Y "�`$�'' FINIBHINILlI6' <br /> 45 <br /> 001 <br /> START MILES, <br /> TOTAL MILTS' <br /> t BTARTTIMI3• + AM(q <br /> ON SITE TIME AM PM <br /> y`h`.:, OUT 71MI ASA PM <br /> FINISH TIME r AM M <br /> q� 'bNr <br /> EMO <br /> ),Jf ; Lv OVERNMgNT ❑LEA EXEMPT OTHER <br /> •-• ix•-�.f. , �• 'p12AGRICULTLIRE O COMMON CARRIERMAC <br /> h ICK UP <br /> Q IMPORTFROt41 ` ` WHOLE LIRE COUNT (DYWEIGHt IN POUNDS <br /> DiwLIVERY + VOLUME CUStC YARDS 0 WEIGHT IN TONS <br /> O EXPORT TO , <br /> o Dare a oorttty that under oelalty of pfrjutylupph�r the IGw ►uta State of Callrvrnio that the Information provldod above la true and eofroaA In addition,l i <br /> pp1 j am aware thal,falclfication of EhIO Inforirledon result In c1VII pohalift up 528,000 per day,per violence or admini£tr9dv0 pOnaltlao up to 9 <br /> $5,000 perviotation per doyaa daaorlbad In Publlo Resoumve Code=91on 42962, <br /> CUSTOMER PRINT NAME CUSTOMER SIGNATURE DATE <br /> lR'e c it:e d j— I e �`e b 14, 2014 1 : 19 AMPLNrLkt0iC6t,:IRCLE STORE LOCATION AT TOP - <br />