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Apr, 24, 2808,; 2:44PM;. COlIkIELL TIRE/GOLDEN TATE TRUCK No, 6481 P. 8
<br /> 'LSQ. vA r. i 1r r- to u. .f v4. FLEET SERVICE RECORD
<br /> (1.s." TIRE'SALES TPiD 1000817 137
<br /> Md!IN11sort Way rim..,.;Wl�aca,Way T7rs lFtKea ;'Rtr�t�mYr *iieS a #WMeson Way Tfro #21 US Tyro Sefea 420 US 7Ve Safes #M Us tyro Safes
<br /> 221 t1.Wffaon Way .113.11%Qavonth IP. 2800 Yosemite Bivd lglf ReUonef Ave. e530 Frenkffn Blvd,
<br /> akton,Co.96209 SteFktpq,Ca D5Te5,., r, ..Stochtonr t:a.96206 TMQFI 0^on?$ Modesto,CA.81354 mayward,Ca.945" Sacramento,CA.83823
<br /> 2(.'8400-0381 so8+4¢5�92es'..�.: � 40 d6b 8f'` 7 2OM71.5011 519-097.1292 91e-39s szag
<br /> CUSTOMER ;.' ' vt 1E`.h'`c�f,t.t. s: 't;, k.:•'' P.O.#
<br /> 3' fl DATE
<br /> PHONE VEHIQL
<br /> LICENSE#
<br /> L
<br /> LOCATION OF•SJ=RVICE " STAT ZIP QQOE
<br /> CUSTOMER TPI'D DECAL#
<br /> I cenify that under penalty of oer)ury"under the laws of the Slate of California that the Inform ovldod a vs le correct a Itlon,1 em aware that falsification of
<br /> thls Information may result in ous nal n;'revetatlon,dr donlal-of r 'al of the He r Reglatr on to Pu Resou es Code section 42960 and may
<br /> result In civil penaltl0b ti 6, 'Qtly; Y'(1F la ?oKedmintst nalttes up fa$ , 00 per v etle ay as Abotl I ubllc Resources Code section 42982.
<br /> bRIVER NAME ', DR�!ER S ATU DATE
<br /> MAKE LICENSE STATE ODOMETER/HUB
<br /> �� f r .t; �• f. � 'r���y
<br /> r �
<br /> (Yr"�e,`4'.$�c.n:..,.+�.�`_'', e�lg.��`.•r r? r. ri cA ... .,,�,._--•--
<br /> 1 SEtaVlpi^C(jL� w:.-v- ;,LT
<br /> MOUNT I DISMOUNT(S)ON VEHICLE BRASS VALVE STEM(S)
<br /> FLEET INSPECTIdN^ M MOUNT/DISMOUNT(S)LOOSE ALUMINUM STEM(S)
<br /> AIR SERVICE .;•;,t,, ,; ;,, LOOSE MOUNT(S) VALVE STEM REBUILD(S)
<br /> FLAT REPAIR(S)'.„• ';,i:;rrty� lts .tl ,,.:.3•.t{'f t•', ,; a; .:LOOSE,DISMOUNT(S) ALLIGATOR CAP(S)
<br /> REPAIR MATEAIAL(S);�"�a.,`+ t.;,1 TIRE(S)t3ALdIQED METAL VALVE CAP($)
<br /> WHEE4+ka',, RECONOITI. NED:WHEEL($) O RING(5)
<br /> �..• , - ( u FINISH MILE$:—1
<br /> I f?(7 r q� START MILES; �'
<br /> 8 � .'�G7 �++ ' 1 :` z _^;;e.v:i - ;?� ;,::r r.• s;. ,� TOTAL MILES: -36
<br /> —7 . wO ?1rw, ^f 11.-
<br /> — od
<br /> START TIME: PM
<br /> .: —
<br /> O ON SITE TIME: AM PM
<br /> OUT TIME: AM PM
<br /> FINISH TIME, AMO
<br /> LOAD AMOUNT'.;", %t'`,` i 'µy
<br /> r- k, 'Al�� Rt+71ir?
<br /> a x r � �7 GOVERNMI �Jra. ❑ LFA EXEMPT ❑OTHER
<br /> []'COMMON CARRIEWBACK HAUL
<br /> ❑ PICK Up
<br /> ❑ DELIVERY ORT FRAM El WHOLE TIRE COUNT ❑WEIGHT IN POUNDS
<br /> C3 EXPORT T(} [c ❑VOLUME CU1310 YARDQ ❑WEIGHT IN TONS
<br /> heffsl lipy of'thle la`, under
<br /> t m.9lay 0111agbilh n tate Of enCaltlforulatthat the
<br /> formation provided above Is true and correct.In addition,I
<br /> p per day,per vlofatlon or sdmintstrative penalties up to
<br /> $ I'`'' t c t✓t" dE 'Qat t l�: f;i."In P;I(00..04vdu►,ees Code section 02962,
<br /> ' U;&tfl�7EF�'PAINT NIfE
<br /> :,.CUSTOMER SIGNATURE
<br /> (i f��r DATE
<br />
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