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FLEET SERVICE RECORD <br /> WILSON WAY 77RE CO., INC. I <br /> U.S_ TIRE SALES TPID 1000837• 7 1 --14 <br /> 023 US Tim Sales 024 US The Sales <br /> #21 US Tho Salos 6530 Franklin Blvd. 1• <br /> IYi s; tlln r7n. rr4lsnn lY y Tire R—ap #D2 C—nell Tire 1915 Neflonal Ava. Sacramento,C 58 <br /> 2600 Yosomlro erov. Hayward,CA 94545 <br /> IY.1y 1515 MnrAet SL 2211 N.INllsnn IYaY Aiodesfo,CA 95354 pi ti-3Bb2245 <br /> C4 B5\15 2t",Afo n,CA 95205 SfocAfon,CA 95205 510-8B7-1T82 <br /> 45cr:Fr :09165-3262 209-166-2581 209-57l-Sfifi <br /> DATE <br /> P.O a <br /> PHONE.-- VEHICLE 1 <br /> LICENSE# <br /> -� STATE <br /> DECAL# <br /> CUoTONTER TPID <br /> r o <br /> -a b,at under pe—Ity of perjury under the laws of the Stale of Callfomla that the Information provided al>ova Is true end correct.In addition,1 am swan that alslllea� <br /> may result In suspension,revocation,or denial of renewal of the Waste Tiro Hauler glsyallon pur]uanl to Public In Public <br /> Coder e-Code <br /> se and m <br /> pe,iYlss up to 525,000 per day,per violation of adminlstntivo penalties up to$ <br /> 5,000 o via/atlon per day es described In Puhlle R�soureea Code secllon<2902. <br /> DATE <br /> DRIVER SIGNATU - <br /> Q / <br /> r� d <br /> e •- - <br /> TRUCKfTRAILER ii LI ENSE STATE ODOMETERIO <br /> SP INSTRUCTIONS ON OFF— _ <br /> _ DS_PrP T,Ory OF WORK COMPLETED QTY, DESCRIPTION OF WORK COMPLETED QTY DESCRIPTION OF WORK C ED <br /> 0 <br /> %ALL MOUNT 1 DISMOUNT(S)ON VEHICLE BRASS VALVE STEM(S) <br /> ".aPECT10N MOUNT/DISMOUNTS)LOOSE ALUMINUM STEM(S) <br /> _E?';CE LOOSE MOUNT(S) VALVE STEM REBUILDS) <br /> ;L --===-.6R(S) LOOSE DIS IOUNT(S) ALLIGATOR CAP(S) <br /> PEZ;A.)F.LIATERJAL(S) ) TIRES)BALANCED METAL VALVE CAP(S) <br /> .c.5`rVITCH{S) RECONDITIONED WHEEL(S) O RING(S) <br /> PRODUCT INSTALLED <br /> "—� FINISH MILES: <br /> f f I] J START MILES: <br /> TOTAL MILES: <br /> _ter t' START TIME _ Ant Pmt <br /> ON SITE TIME: Ant PM <br /> OUT TIME: AM PM <br /> FINISH TIME. Ant PM <br /> pEXEMPTION IF APPLICABLE <br /> ac RAIMENT ❑LEA EXEMPT LJ <br /> R�Gl��.suF ER/ <br /> COMMON CARRIBACK HAUL <br /> LOAD TYPE <br /> U WHOLE TIRE COUNT <br /> U WEIGHT IN POUNDS <br /> G VOLUME CUE31(;YARDS WEIGIiT IN TONS <br /> fyNr 1J.t:1r +y4Mfd*ifthtl lava of 1116 Stals of t.allfOrftla that 1110 Information provided above Is tme and corract In addition <br /> Mr'tlpMlll� flh6r Ndof o"On may moult In clvll (lrnaltlus up W.000 pnr day, hof vinUilion or adminlstrativn ponalties up <br /> / I9040k!`ow InPHWkpasourcoitCodosecuon429r:. <br /> �.i1s7c IItN: 1'}Wcpilli(I ;- Cl!3Tt?MCH 51GNAIILAI L DATE <br /> i ^t >� 1 <br />