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-AVN -2000(WH 08 06 I - 00 Tracy, CA (FA ��983486T0 P. 009/O1
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<br /> son Way, Tire Co.,. Inc. Field Service Work Authorization
<br /> 221 N.Wilson Way 7211 N.Wilson Way
<br /> 21 2600 Y,7Sgmlle Blvd"! 6530 Franklin Blvd,
<br /> i STOCKTCN,CA 95205 STOCKTON,CA 95 MODESTO,CA 95354 2a SACRAMENTO,CA 95823
<br /> (209)405.0261 (209)466.2581 (249)571.5611 (916)395-2245
<br /> 1133W.111h Slroel
<br /> BAR#AA002949 BAR#AA107509 BAR#AF167037
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<br /> TRACY,CA 95376"- z 1915 National Ave.
<br /> (209)835.4067 273HAYWARD,CA 94545t
<br /> 13AR#AF 184429 (510)807-12e2
<br /> DATE
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<br /> PREPARED BY ' ^rJ � •� � •Ifi
<br /> p 1 NAME PHONE
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<br /> DRIVER'S SIGAlftTURE '�9
<br /> (1 STREET AND NUMBER
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<br /> SALE INV.NOJD-9 NO.
<br /> '/ 0 CITY 1 STATE ZIP
<br /> MILEAGE/,HOURS VEHICLE,'#I"'y"+°' �'':'LICENSE'S '''q', MOUNTEDtlNT ACTOR'R 'MOUNTED-ON TRAILER# P.O:V1 UR05RED By
<br /> " s .,; 1'(" '''i.`•:i;'" ".f. 'ii•,' rli'1','OLOCATION OF'SERVICE'CALL i ,lrl'• p,,i(( .( y,,4 •l',' „•,ii a •a
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<br /> QUANTITY1�I
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<br /> NEW TIRE/RETREAD
<br /> FIAT REPAIR
<br /> ai6J��A)l1 �( .;'� MOUNT/QI5 T .,
<br /> SERVICE"CALL
<br /> WHEEL SWITCHES
<br /> BALANCE'
<br /> O'.RING
<br /> REPAIR MATERIAL
<br /> STEM E
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<br /> QUANTITY '�„i :!"„'1 , RETREAD WORK ORDER;NUM8E1�'h;'"' ++,.:]' QUANTITY! '": —TIRE'OIEPOSAL ,'
<br /> BERVICETRUCK';NUMREq",f' '' i,,,; `j lis`.'r�°TIME'.DLIT•^ r`•;` > p,�ti '•"Yi' TIME IN THIP MILEAGE,
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<br /> CUSTOMER PLEASE READ R SIGN THIS STATEME OF ADJUSTMENT INVOICE
<br /> THERE IS NO CL TM FOR OTHER DAMAGES CAUSED AS THE RESULT OF,THE TIRE(OR TUBE)PAIL RE REPRESENTED IN THIS ADJUSTMENT BI 1
<br /> MADE BY THE PENERAL TIRE 6 RUBBER COMPANY; AND IT IS UNDERSTOOD THAT ANY CLAIMS THAT HAVE NOT©EEN SPECIFIED TO THE
<br /> REPRESENT VE A E HEREBY WAIVED BY THE UNDERSIGNED,IT IS FURTHER UNDERSTOOD AT THE ADJUSTMENT ITEM(S)WILL BE SEN :I
<br /> THE G A 5TIy1i(T C FT FOR FURTHEq INSPECTION.
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<br /> CUSTOMER PRINT NAME CUSTOMER SIGNATURE DATE
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