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r' �•-1 a f 1"L_ 4`or.' IIV('' FLEET SERVICE RECORD <br /> .S. T1RR SALES r <br /> 301 1Nneen tYpy Tlr* wits*„Wa ripe e ���� T:u".1000837 121083 <br /> Way �A >fo2 Conseil Tlra Bos Wkeom W Tiny <br /> 221 N'iNl�Way 1825 Market St. ay #21 US Tie,Sates <br /> Stockton,Co.9SMS S 22Y Y N_Wlleen Way f 1.3,0 W.4eve dh St. oe #24 us Tire Safes <br /> rocktoq Ce.t)62a5 Stockton,Ca, 260p Yeser>,fte Blvd. 1818 NpUy�(AYe. 6530 Frankth,Blvd, <br /> 204�f65.OSBf 85203 Tracy,Ca.8fJ376 tNodwstq CA.95$Sq !te <br /> 208i6S J2G2 2�t662dat ywarr6 Ca."50 Sacramento,CA.8a, <br /> �osl sas ao6s aosaTr.esY 1 <br /> CUSTOMER 51"87-12&4 <br /> DATE <br /> L <br /> PHONE VEHICLE# / <br /> LICENSE# J <br /> LOCATION OP SERVICE <br /> _ <br /> C f+ STATE ZIP CODI <br /> 1--i-TA <br /> TPfD � i �� 1 <br /> DECAL# <br /> I certify that under penalty of Perjury under the laws o1 the State of Cali <br /> this information may reault In au fornls that the infor ---- ' r <br /> y spanafOn,rovecaHon,or denial of renewal pt the Waste Tire allon p Rvdtdaa eve Is true and correct.in addition,I am aware that falsification of <br /> result In civil penalties pp to 826,000 per day,per violation or administrative penalties a it <br /> DRIVEF1 NAME P 45,000 per violation Purdue a to Public Resources code rceS n 42Mand may <br /> I per day as described In PLrblic <br /> DA Resources Code section 42962, <br /> DRIVER S NATURE <br /> DATE <br /> MAKE • M-IF&I VIER, <br /> TRU KITRAILE • • <br /> LICENSE STATE <br /> C <br /> UB <br /> 6 <br /> it kl;. <br /> J.riJJ Lvi 1�'; ■ '.J�r1`.'r`,';���tQ�afl'�'.Oi421%Y.�.�y,�;)�.if�,'..�',y ti�b,.bF;.Y;w' fGN�:a�'Jy�,r,. ., <br /> 2•Y zrySCf�lA,�j.4„N,� wA'.�?,,C P. .+., <br /> SERVICE CALL i "'" ED r,.:• c1 C?TY`s•; ;i .iaESC.R1P71Q(V OF <br /> MOUNT/DISMOUNT(S)ON VENICE <br /> FLEET INSPECTION W 13RASS VALVE STEM(S) <br /> MOUNT I DISMOUNT(S)LOOSE <br /> AIR sERvic>; ALUMINUM STEM(S) <br /> LOOSE MOUtVT(S) <br /> FLAT REPAIRS) VALVE STEM REBUILD($) <br /> ` LOOSE DISMOUNT($) <br /> REPAIR MATERIAL($ ALLIGATOR CAP(S) <br /> TIRE($)BALANCEDWHEEL SWITCH(S) METAL VALVE CAP(S) <br /> RECONDITIONEE)WHEEL(S) <br /> FINISH MILES. <br /> START MILES: <br /> TOTAL MILES: <br /> STARTTIME: <br /> GO AMI ) <br /> N SITE TIME: <br /> AM PM,/ <br /> OUT TIME; AM PM <br /> LOAD AMOUNT ; �.ISH TIME: <br /> LI:R- I?MP AM PM <br /> ❑ GOVERNMENT TMdN N='A�?P!ICAt3lE } <br /> ��~~ •~� d AGRICULTURE ❑ LEA EXEMPT <br /> PICK UP ❑COMMON CARRIER/SACK HAUL ❑OTHER <br /> IMPORT F M rpl] <br /> RO <br /> ❑ DELIV RYcjgti <br /> WHOLE TIRE COUNT <br /> expORr To ❑WEIGHT IN POUNDS <br /> VOLUME CUBIC YARDS ❑WEIGHT IN TONS <br /> o°��Dero M 1 c aw that under Penalty of Perlury under the fawe of the State of California that the information provided above Is true an <br /> am aware that falsification of this information may result in civil Penalties up to$25 000 day,per violation ore Is true <br /> c <br /> 36,000 per violation per day as deserlbed In Public Resources C d correct.a addition,f <br /> w <br /> �- ode section 42962. Penalties up to <br /> Wil- <br /> FSR O. OMEH P ME CUSTOMER SJ* E <br /> l 'd - S[66 "N lSH—Dti 6H '00 hIl AVM NOS1IM AVL[ : [ [ SOH U 'IV <br /> 1 <br />