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s:. <br /> FLEET SERVICE RECORD <br /> WILSON WAY TIRE CO., INC. <br /> U.S. TIRE SALES Tplp 1000837• 752174 <br /> I23 US nro Sales <br /> 024 U37#ro 8alea <br /> a7f u5 rlrr Sales 19 is NarlonelAve. SS3o Prankllrt Blvd. �� <br /> r^n IST.t.4 M Ivan ST Hrr9p 221 Crnnel!7719 7600 Yosemlt9 Blvd. CA 94545 Sacramento,CA 018:1 C D <br /> r�rJ wm�er Sr. 221 IF N.Wilson W03 Modesto,CA 53354 Hayward, itD Qd•13A0.'; _ 2 <br /> J;,ys Srt—Aron,"A 95:05 Sr—lkfon•CA: 510-987-1282 <br /> e*l.t..'• �S• _y'p...r6y'.1.67 209-460-2551 207-571-5611 , <br /> P if <br /> DATE <br /> \ F'hIDNE VEHICLE n <br /> r <br /> --- ------'--'----—�.---...----.—'— - LICENSE If <br /> STATE - � t•°^ ''21PCQyI1�„ <br /> laf <br /> _. CLISTOMER TPID r •; , 11 f Ly — (,.! �r DECALa / ry' <br /> ;e tfi C+at•.,nee+peraM a#nequry under the laws of IM State or Callfomla That Ih9 lnfortnellan provld9d shove Is true and eortecL In addition,I am ewaM lha£filslflfxUon 01 _ {) <br /> maNz-,mad result rn suspension•revocation.or denial of ronowal of the Waste Tire Hauler Roglstratlon pursuant to Public Rasourcae Codesection4i,s �^d�?�y6� <br /> �I-c-�t penallies up to 5:5,000 per day,per violation of administrative penalties Up to SS,00it per violation per day as described in Public Resources Code ep'ttlon,. <br /> �.AME gRN6R'61GNATURE- GATE ,.`. <br /> = TRUCIGTRAILER 0.1 <br /> LICENSE STATE b.' <br /> _ f <br /> _ Vll '^ <br /> SPECIAL INSTRUCTIONS ON <br /> 1.FQUJ <br /> - L Y LETED QTY QTY DESCRfPTld�fn rV(L f Q P, <br /> .ti�wcw:cau.�� <br /> ` R !DISMOUNT(S)CEy_FHtCLE BRASS VALVE STEM(S)' <br /> LE--- I'.===^--;O` MOUNT DISMOUNT(S)LOOSE ALUMINUM STEM(S) <br /> »= LOOSE MOUNT(S) VALVE STEM REBUILD(S) i <br /> — .T?c= .�5 - 7 <br /> LOOSE DISMOUNT(S) ALLIGATOR CAP(S) <br /> ='4•R i'� '- TIRES)BALANCED METAL VALVE CAP(S) <br /> 4'4 E-S,'y.�'='.= RECONDITIONED WHEEL(S) O RING(S) <br /> PRODUCT i <br /> / DESCRIP ON FINISH MILES: <br /> '� G F4/ 1� n..- ,) P START MILES: <br /> 11`•f k'' _ }�, �� a <br /> TOTAL MILES' <br /> -- — -- -- �� START TIME: <br /> LS—. �fz 7 �i ON SITE TIME: AM PRI <br /> OUT TIME: AM Ptd <br /> --- — FINISH TIME:_— ��) <br /> HAULER EXEMPTION IF APPLICABLE <br /> LEA EXEMPT [)OTHER <br /> Cr CARRIERIBACK HAUL <br /> LOAD TYPE - <br /> t1%010.E TIRE COUNT T �11 - <br /> VEIGHT IN POUNDS <br /> 1 .t J'/()'_LIME CUBIC YARDS ]WEIGHf IN TONS <br /> the aks ryr the Fita#n 7f t;aiRotnlA iftaf!ha Ht�rirrllatlprl provided✓&faOVB Ir;t11 <br /> rory rAe.:H<r r,Ivu pei'l, is up Ii25 04110 par day.par riotAtlan cr sd,ni Isirativa pgaaIti" u1,10 <br /> •. i(•.-'. 4. �,: _ - .. . kgi.t•yrr.+ti#.�c!le!!<'.l i#i71 AaWfil <br /> f <br /> �. ClI:aTCI;IAr:R'i7CNR,TURF <br /> a ij 1 t7 `,I 1 y BATE <br /> t <br />