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From: 11 /01 /2013 07:44 #386 P.004/005 <br /> 1-209-242-3051 13:02:40 10-31-2013 4/5 <br /> ! t MZYUN WAY TIRE Co., INC. . FLEET SERVICE RECORD <br /> U.S. TIRE TIRE SALES <br /> TPID 1000837, 15 3 7 4 9 <br /> $01 MI-San Way 77ry Wilson Way Tire Recap #02 Connell 77ru #21 US 77ro Sales <br /> 221 N.W icon Nay 1835 Aforkot St 2211 N.WI/son Way023{/S Tfre Sales. 924 US.77ra Sales <br /> Stockton,CA 95205 Stockton,CA 95205 2600 YOcemUa Blvd. 1815 National Am- 8530 Franklin Blvd. <br /> 2"485-0261 Stockton,'CA 65205 Modesto.CA 95334 Heyward,CA F4545 Sacramento,CA 9582: <br /> 209 4uFr3262 ]09 4titi zSB1 209.571-sell 610.807-1292 <br /> CUSTOUER 91"5.2245 <br /> P.O.M DAIS <br /> PHONE VEHICLE — <br /> LICENSE <br /> LOC ON OF S ICE _ <br /> r STATE ZIP CODE <br /> CUSTOMERTPlD l DECAL# �— <br /> I certrfy that under penalty of perjury under the laws of the State of California that the Information providsd above is true and correctlll In additioa�i�dd���itiollln,I em aware that falelticatlon of <br /> •this Irrformalion may result In suspension,rvvocapon,or tlants}of'renevrai of the Waste Tire Hauler Rat;tstrallan pursuant to Public Raaourcos Code"Coon 42980 and may <br /> result In civil penattiec up to$25,000 par day,per vlolatlan of admlhfstrative penaWas up to$6,000 per viclatlon per day as described In RE public Resources Coda section 41982 <br /> DRIVE E DRIVER SIG <br /> X DATE <br /> iA • . <br /> MAKE TRUCKlIRA!LER it LICENSE STATE <br /> 'ODOMET1e tWa- <br /> WMEMMM <br /> • r <br /> MMM <br /> SERVICE CALL MOUNT/DISMOUNT(S)ON VEHICLE <br /> BRASS VALVE STEM(S) <br /> FLEET INSPECTION MOUNT/DISMOUNT(S)LOOSE ALUMINUM STEM(S) <br /> AIR SERVICE C(OSE MOUNT(S) VALVE STEM REBUILD(S) <br /> FLAT REPAIR(S) LOOSE DISMOUNTS) ALLIGATOR CAPS) <br /> REPAIR MATERIALS) TIRES)BALANCED METAL VALVE CAPS) <br /> WHEEL SWITCH(S) RECONDITIONED WHEEL(S) O RING(S) <br /> FINISH MILES: <br /> START MILES: <br /> TOTAL MILES' <br /> STARTTIME: AM PM <br /> ON SITE TIME AM pM <br /> OUT TIME: AM pM <br /> LOAD AMOUNT. LILIMMIMMMIM FINISH TIME, T—AM pM <br /> ❑GOVERNMENT ❑LEA EXEMPT La OTHER <br /> O AGRICULTURE COMMON CARRIER/BACK HAUL <br /> PICK UP <br /> .IMPORT FROM <br /> ELIVERY WHOLE TIRE COUNT D WEIGHT IN POUNDS <br /> O EXPORT TO <br /> VOLUME CUBIC YARDS L]WEIGHT IN TONS. <br /> c Da1Q I certify that under panatty of perjury under ttte Iowa of the of Cslifomla that the Information provided above Is true and correct.In addition,I <br /> `od am aware that falslflcetton of this lnfarmatlon may rvsull i Ivll pa a a up$26,000 <br /> JtY _ 66,000 psrvfolstlonperdayan ds bed In Public Resources Code ce 42682: .IMr days per vlotallon or admin lstrettve panaltfss up to <br /> CUMMMER/rPRINT/ NAME Co TO ER SIGNATURE <br /> FSR No. 153749 °" <br /> PI FQSt=f:IRr`1 C G'T/lOC t .•,r.,,,-,,;., .�...�.� <br /> Received Tlme Nov, 4. 2013 7:41AM No, 0870 <br />