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04/01/2006 TUE 13: 20 FAX 2099636122 0003/006 <br /> ,p WILSON :,4Y TIRE CO., IN _FET SERVICE RECORD <br /> U.S. TIRE SALES � � i 3 106128 <br /> TP1D 0008 7 106 <br /> ,rot Wifewr Way Tiro Wlrapp WOy Tl-Racap� *62 Go eIt 71to 205 W116on Way Tire x$21 US Tire Sales 229 U9 71re safes f70 09 Tin Sales <br /> R21µWilson Way IW5 Markal St. 2211 It Wilson Way 1 f3]W.Eleventh St. BBDO yeew"fro BNd. 6530 F iin Blvd. <br /> 6toakton'Ca.6640a sloekfan,a.95205 stmicton,CO.95205 Tracy,G.11!uya madpetsy QA.05954 NaywArd'Ca.04545 Sacramento,CA.45629 <br /> 904466.0261 8d940&9?SZ 20%-066..2541 Qd9.B7a4pe7 206.5yY56Qf iT 0007.1502 916•aB5.20" <br /> CUSTOMER P. DATE <br /> VEHICLE <br /> LICENSE <br /> LOCATION OF SERVICE STAT ZIP CODE <br /> CUSTOMPF1 TPID �_� ��_ I— C^�l DECAL if <br /> I certily that under penalty of parlury under the hlWS of 1110 Slats oLGallfarnlo thet the Informalfo vlded ova1s true and correct.In addillon,I am aware that falsification or <br /> this Information may result I su ension,revncsllon,or denlnl aal of lite au Magi anon pus f ubllc Resourcaa Code secilon 42940 and may <br /> result In civil penalties up to zs, 00 per dsy,per violation or edm naRlsa up to S. <br /> 0 par ianon p d i doses! bllc Resources Coda aeetton 42962. <br /> DRIVER NAME v IVER$I DATE <br /> LO <br /> MAKE TRUCK/TRAILER# LICENSE STATE ODON1ETER[HUB <br /> SPECIA :'INET <br /> RUC: <br /> TIO <br /> YvIc, e <br /> �v��s� 8°� 2 fes— __— :_..._.-- — •— ___ —„ �_ <br /> - OTYt ._D>;SCR/F77QN pF,WDRK(r�MPI.FTED <-.: ;Q�'�', :, ,:[IESGt�iR,T(QN•:D.FIKOAK;GOMP.L�T6Q�;�;i�.'d1'Y' .a$?' ;DtrS�R(P,Tlti�lv�?+°`-.WOAK?GOMPt_ETEO_;�;�r <br /> SERVICE CALL 4 MOUNT i DISMOUNT(S)ON VEHICLE BRASS VALVE STEM(S) <br /> FLEET INSPECTION MOUNT/DISMOUNT($)LOOSE ALUMINUM STEM(S) <br /> AIR SERVICE LOOSE MaUNT(S) VALVE STENT REBUILDS) <br /> FLAT REPAIR($) LOOSE AISMOUNT(S) I ALLIGATOR CAP(S) <br /> REPAIR MATERIAL(S) TIRE(S)BALANCED METAL VALVE CAP(S) <br /> WHEEL SWITCH(S) RECONDITIONED WHEEL(S) O RING(--)NNW PROF <br /> FINISH A' M -- <br /> 7NQTY. <br /> START MILES' <br /> TOTAL MILES: <br /> START TNE' <br /> ON SITE TIME! AM I'M <br /> OUT TIME; AM PM <br /> FINISH TIME: 3 M <br /> ,a i °' r.? "1- 'SL'nri t.,'• `,...,r �'°F.. ^L. " °'AB= <br /> t,OAD AMOUNT .� ` <br /> ❑GOVERNMENT ❑LEA EXEMPT THER <br /> --- —'---- ❑ AGRICULTURE ❑COMMON CARR(FR/BACK HAUL <br /> lftCK UP / <br /> O IMPORT FROM DoLY � <br /> L' _ El TIRE COUNT WEIGHT IN POUNDS <br /> LIVERY <br /> l A) ❑VOLUME CUBIC YARDS [IWEIGHT IN TONS <br /> ❑ EXPORT TO tA—) <br /> I c"ty that under ponaity of per)ury'undst the Iowa of the State of CaBtornle(hal the Informallon Ovid d above Its We and corroot In addition,I <br /> u DafaT am aware that falsification of this Information may mutt In Civil ponaltios up to$26,000 per day, er vl tion or administrative penalties up to <br /> y 'Qe <br /> $5,1100 pe*violation pit day as described in Fublfo Itesoureo6 Code ee 2962. / <br /> CUSJTOMEfl P rme CUST ER 31 A 047E <br /> FSR Ni �IF 'I_�C't� ='hd y(I�—Zb� 6(?Z (?� 3'�? I �H+'t PJ�:>i'fllbyl"I:b �:iilU " <br />