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Rx Date/Time OCT-20-20`' TUE) 13; 32 2D946731-- P 002 <br /> 10/20/2009 06:28 20946', ;5 WWT TRUCK PAGE 02 <br /> t WILSON WAY TIDE CO., INC. FLEET SERVICE RECORD <br /> U.S. TIRE SALES TPID 1000837. 14 7 5 01 <br /> #01 141/son Way?ire Wilson VWy Tarr.Recap #02 Connelf Tim #21 US Tire Sales 923 US fire Sales #24 US Tbr.Sales <br /> 221 N. Wileen Why 1535 Market St. 2211 N.Wilson Way 2600 Ywww";le Blvd. 1915 National AVe. 6530 Franklin Blvd. <br /> Stockton,CA 95?.05 Stockton,CA 95205 Stockton,CA 9$205 Modesto,CA 95354 Haywand,CA 94545 Sacr;rrg nto,CA 95823 <br /> 209.405-0281 209.465-3262 209-466.2581 209.571-5611 510.887.1282 <br /> CUSTOMER P.O.ft DATE := <br /> �\ PHONE VEHICLE <br /> LICENSE <br /> LOCATION OF SERVICE - /7 STATE ZIP CODE <br /> CUSTOMER TPID ; -I DECAL>F '} ? <br /> I errtify that undor W.nalty of perjury under dw laws of the Stair.of CaNlornla that the Information provided above Is tare and corract.In-Adnlon,I am aware Wit faletfiostlon of <br /> this Inforrrl3Mon may result In suspension,ravocation.or denlel of renewal of thn Waste Tire Hauler Registration pur uaM to Public Rosourcoa Coda section 429110 sad may <br /> result In civil psnaltlns up to$28,000 per day,per violatlon of adminintratIve penalties up to$5,000 per violation per day 99 descrlbod In Public Resources Code secilon 42962. <br /> DRIVER NAME D Eft IGNATIJ DATE <br /> . �5 <br /> MA TRUCKITRAII.ER# LICENSE STATE ODOMETER/HUs <br /> SPE1✓'IAL IiV ttrls: ; ,.tom: :�" <, aJ �', _ <br /> T <br /> OFWbIIr.CiDnIPLET�Di:;:',> Qri�:: _Ot`SbfIPTIGIIYL_F__ KrL "lEf ;Qri' - eE57;trPrr�rii;_?_Wdkircv:l°►�_t : <br /> SERVICE CALI) MOUl I DISMOUNTS)ON VEHICI.F . ` 1 T BRASS VALVE STEM(S) <br /> ... - <br /> FLEET INSPECTION MOUNT/DISMOUNT(S)LOOSE ALUMINUM STEM(S) <br /> AIR SERVICE V LOOSE MOUNT(S) VALVE STEM REBUILD(S) <br /> FLAT REPAIR(S) LOOSE DISMOUNT(S) T AI.LIGATOR CAP(S) <br /> REPAIR MATERIAI_(S) LL — - TIRE(S)BALANCED METAL VALVE CAP(S) <br /> WHEELSWITCH(S) RECONDITIONED WHEEL(S) 0 RING(S) <br /> IzrY: is ::.......;SIj,E::.'':;:' ..:...:...... FINISH MILE <br /> y[, START MILES <br /> ll <br /> TOTAL MILES: IJ <br /> / Va L/ START TIME: _—AM <br /> Gam+ �. t_0 V11illfONSITE TIME: AM PM <br /> 01- <br /> j'? �,. —.—_—_ OUT TIME' M AM PM <br /> FINIS14TIME- ••'+✓: AM <br /> LOOUNT <br /> AP AM <br /> .._:,:Aa.:,;,�-�l•%.:.. ...�u��ryi� 'l.rA!{.i:�.: � iar 4l,'� i' <br /> 0GOVERNMENT ❑LEA EXEMPT Q OTHER <br /> •—— ❑AGRICULTURt ; . Q COMMON CARRIER/BACK HAUL <br /> PICK UP <br /> L] IMPORT FROM.. (i 4�Q � _ J <br /> �. 'Q'1NITOLE TIRE COUFai?'r ❑M16HT IN POIJMUS� ~. <br /> O OEL Cl' RPO , '� �1 C A ^ <br /> txPor�rTo 1 / �U ❑VOLUME CUBIC YARDS ❑.WIGHT IN TONS <br /> �c Daro 1 C,-nlfy that under penalty of perjury' under the laws of the St do of CAllfomittlltat the Ihf.OtmWon provided above la true andtorMd.In addition,I <br /> c� pm 1wJm that falsification of this information may r98ult In civil pe altleS Up$25,000 pMr d y,per VfdIlnIoN'$r adm/nr%Tr.htfvn 0iMfMe5 up to <br /> ?� $S,OnO prrvlolallon perda as described Ih Public Rssovtcos Codo s n4206 <br /> C nE pR NAME CUSTO SIGNATURE DATE <br /> FSR NO. 147501 (PLEASE CIRCLE STORE LOCATION(AT TOP <br />