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Ap r. 24, 2008 2:43PM ... , Cn"'NELL TIRE/GOLDEN STATE TRUCK No. 6481 P. 3 <br /> WILSON WAY TIRE CO., INC. FLEET SERVICE RECORD <br /> ' U.S. TIRES L'ES TPID 1000887. 109651 <br /> Aga u5 rim Setae t21 US Tire Satee <br /> A02 poll A03 Wllsan way Tire 11t rlra 191s Matlorrat Ava. 6510 Orankllrt 0i <br /> 401 W7eetr Way TIro wuson way Tire Recap 113,w Ere St. 21l Yeaernrte Bfyd• <br /> psi a .t�.faon way 1326 Mar lit, 1211 son Way 1at.wor4 do.94546 8aclarrrefKar CA.98623 <br /> Steam-A.ra.0i stoo@fo.r,Ca.06209 81 ort,Ca.95295 'fM1aey,Ca.959,16 Modesto,CA.95354 510.987.1182 91r,3911-224929VAId"291 2o9 &3262 20-48111-25111 2094364007 "9.571-6611 <br /> CU TOMER P.O.# DATE 03 <br /> / <br /> HON / VEHICLE# f <br /> LICENSE# <br /> �; 0 STAT ZIP CODE <br /> LOCA SIpN OF SER VIC J <br /> AIV <br /> ,....1• ._._: ,,-, ..--•; „ ;--�_. �/� /S;C'�� DELA # —I+���.1( ,1 <br /> CUSTOMER TPIDf iix' 1J J-J.`-� L_.,.. m <br /> I <br /> certity,that under penalty or perjury under the laws of the State of Cellforttl8 that this information provided above to true and correct.In addition,I aaware that fatelficatlon of <br /> this Information may result In eusponsion,revocation,or denlai of renew?,of the Waste Tire Hauler Registration pursuant to Public Flesoureea @ede section 42960 and may <br /> result In civil penalties up to S25,000 per day' per violation or'adminietrative penalties UP to$5,000 per violation per day as described in PuDATE sources Code section 42962. <br /> DRIVER NAME yJ DRIVER.SIGNATURE <br /> �[ V <br /> MAKE TRUC RAILS ICE SE STATE ODOMETE UB <br /> f s , <br /> Sk <br /> L <br /> SERVICE CAL <br /> MOUNT i DISMOUNT($)ON VEHICLE BRASS VALVE STFM(S) <br /> FLEET 1NSPEC7ION ?. MOUNT/DISMOUNT(5)LOOSE ALUMINUM STEM(S) <br /> AIR SERVIC9 LOOSE NIOUNT(S) VALVE STEM REBUILD($) <br /> FLAT REPAIR(S) LOOT DISMOUNT($) ALLIGATOR CAP(S) <br /> REPAIR MATERIAL($) TIAE(S)BALANCED METAL VALVE CAPS) <br /> WHEEL SWITCH(S) " "RECONDITIONED WHEEL(S) O RING(S) <br /> m PINISR MILES: <br /> 1 P / START MILES: <br /> h _ —4:• .` <br /> 4 �+ TOTAL MILES; <br /> START TIME, G <br /> ON SITE TIME: AM PM <br /> OUT TIME: AM PM <br /> FI37 <br /> NISH TIME: r^' 6 A PM <br /> LOAD AM4UN ` � a i};�.•.'N::y o+` "{<i;RY <br /> E COMMON CARRIERJBACK <br /> E] GOVERNMENT` O LEA EXEMPT O OTHER <br /> —�..�--�.,. • Q AGRICULTl3R O HAUL . <br /> •(; . : qq �ggr'al >�, " ;�}! '!u",� <br /> Er PECK r }1i_ S' Ak .e ., `•" 5:: d;i^,iK:�?Y ,sir, Y ft <br /> IMPORT FROM l df�'- <br /> / r ;;""" ffWHOLE TIRE COUNT O'WEIGHT IN POUNDS <br /> © DELLY �/ '/� VOLUME CUBIC YARDS [j WEIGHT IN TONS <br /> EXPORT TO . ,C.Q1!t `I l/� t- <br /> I eertl(y that updbr penalty of"porfury under the!aws of the Stale of California that the Information provlded above Is trua and correct.in addition,J <br /> oQtie Dat* am aware thel feisl+laatferS of this rpfarmatlon may rosull in civil penalties up to per day,per vlotetlon yr administrative penehfes up to <br /> s , i C e 00oot toletln ' s <br /> RI ctlonS 4 62A.R <br />