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C� WILSON WAY TIRE CO., INC. FLEET SERMCE RECORD <br /> U.S. TIRE SALES TPID 1000837. 13 7 9 7 0 <br /> 001 Wilson Way Fire VYihwn Way Tire Recap 902 Connell 77re 921 US fire Sales x123 US The Sales 024 US Tire Sales <br /> 221 N.WSW Way 1935 Markot SL 2211 A Wilson Way 2600 Yosendta Blvd. 1910 National Ave. 6530 Franldln Blvd. <br /> Stockton,CA 99108 Stockton,CA 952W Stoctaon.CA 95295 Modesto,Q4 93354 Hayward,CA 94840 Sacranumla,CA 99623 <br /> 209-469-0261 209-463-3262 209-45&2581 2D9471-5611 610-887.1282 916-3912245 <br /> CUSTOMER / � /J P.O 11/jlm z— r1 DATE .6- - pA <br /> PHONE 1 VEHICLE 0 <br /> l <br /> LICENSE 0 <br /> ;�7.c ea �°C 7 P4� <br /> LOCATION OF SERVICE / STATE ZIP CODE <br /> 3 !/ <br /> CUSTOMER TPID4( 'Z — DECAL J .I <br /> I cortify that under Penally of pert ury under the tarns of tlm State of California than the Information provided above Is true and correct.In addition,I am awara that telsHi nation of <br /> Vde Irdarmation may result In euapemam-4 revocatton,or derdaI of renewal of the Weals The Hauler Registration putsuart to Public Resources Code section 47980 and may <br /> reatdf In dull penalttae tip to$25,000 pm day,per violation of adndnlsirative to 88,000 Per violation per day as described In Public Resources Coda section 42882. <br /> DRIVER NAME D TU /DATE� <br /> MAKE TRUCWTRAILER 0 LICENSE STATE ODOMETER/HUB <br /> n I - SPECIAL INSTRUCT]ONS ' ON OFF <br /> QTY. %E&PnION OF WORK COAOWrED QTY nggrlmminy QTY- DESCRIPTION OF WORK COMPLETED <br /> f ERVICE CALL , MOUNT I DISMO T(S)O VEHIC BRASS VALVE STEM(S) <br /> FLEET INSPECTION MO ALUMINUM STEM(S) <br /> AIR SERVICE LOOSE MOUNT(S) VALVE STEM REBUILD(S) <br /> FLAT REPAIR(S) LOOSE DISMOUNT(S) ALLIGATOR CAP(S) <br /> REPAIR MATERIALS) TIRE(S)BALANCED METAL VALVE CAP(S) <br /> WHEEL SWITCH(S) RECONDITIONED WHEELS) O RING(S) <br /> Effidielall <br /> QTY. SIZE MFO DE Ofd FINISH MILES_ <br /> 1,4 2 4,' / � a , �� START MILES: <br /> / I✓ c TOTAL.MILES: <br /> START TIME: J 3 d Aid 67 <br /> ON SITE TIME: _Ain PM <br /> OUTTIME: AM Pm <br /> FINISH TIME: L7�, r Abe <br /> LOAD AMOUNT HAULER EXEMPTION IF APPLICABLE <br /> ❑GOVERNMENT ❑LEA EXEMPT ❑OTHER <br /> ❑AGRICULTURE ❑COMMON CARRIER(BACK HAUL <br /> UrrlCK UP LOAD TYF�E _ <br /> ❑ IMPORT FROM L,� 3y W rHOLE TIRE COUNT El WEIGHT IN POUNDS <br /> ❑DELIVERY <br /> EHOWORT TO a- ❑VOLUME CUBIC YARDS ❑WEIGHT IN TONS <br /> I cur"that under penalty of perjury under the laws of the State of Catitomla that the hltwnratton provided above Is true and correct U an.additlt <br /> Delta t am aware that falsU[cation of this Information may result In civil penalties up 529.000 Per day,Per vlolatlon or adminisb'aSre Penalties up to <br /> a° S3,W0 Wvtolation por day as described in Public Resourom Code soction 42962- <br /> CUSTOMER PRINT NAME _- � CUSTOMER SIGNATURE DATE <br /> FSR No. 1 1 7 q 7 n PLEASE CIRCLE STORE LOCATION AT TOP <br />