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22-OCT-2014 14:03 From: . 2095551212 To:83` '93 Pave:2/5 <br /> WILSON OY TIRE CO., INC. I-LOT SERVICE RECORD 0 ' pl <br /> � U.S. TIRE SALES <br /> TPID 1.000837. 1 7 14 9$ O <br /> IWt wMwn W.V rkre Wilson Way Tim Recap 002 Connen rrre 021 Us Tire Sales #21 us lire SaksI�24us.rue sales <br /> 221 N.YMIso►F Way 1585 Market St 2211 N.MEw Way 2500 Yosemite JBWd f915IVau0rhIAve e5.40 Rvnklfn R", <br /> Sfock w%CA 95205 Stockton,CA a5m Stoekton,CA 95205 Modesim,CA 98351 Nayward,CA 9.4505 saeramento,CA 9b923 <br /> Y09.165.0281< T09aJi5.9262 2k?9aBe•2581 Z09•s71•s61f 61od81-129$ 916+395-2245 <br /> cu <br /> SP MP <br /> �A. A P.O.0 DATEAl <br /> r <br /> 1k"dr r. <br /> PHONE VF-HK;LE;< <br /> i <br /> LICENSE N <br /> LOCA71151V O !CL' j • STATE ♦ ZIP CODE <br /> Cl1STOMERT11I0 all �� / . -6�/I!{ DECALS <br /> I" that under I t <br /> 111 penAky of perjury under the fpr s o1 the State of Cal that the information provided•above is true and:mfl i,In addition,lam aware that folsftation of <br /> thiainrerrnation may rn;suit in suspension,nevecalioA or denial of rsnewal of the Vw4vte Tire ltaui,r F;eglstmtlon pursuant to Roll.Resoureea Coda zecNort{2880 yid may <br /> result in civil penaMles up to t25,1)p0 per day,per oblation of adnlinislralivg penal bes up to SS,000 pet woyHort per day as,desorlbed in Public Reaoureas cads section 42962. <br /> I?RtVERpll n DRIVER SIG E ' <br /> ���s X , DATE <br /> MAKE TRUCKlTRAILER 0 Uf NSE STATE ODOMETMHUB <br /> r <br /> SERVICE CALL , MOUNT 1 DISMOUNT($)ON VEHICLE BRASS!!s!VE STEMS) <br /> FLEET INSPECTION MOUNT)DISMOUNT(S)LOOSE ALUMINUM STEM(S) <br /> AIR SERVICE LOOSE MOUNT(S) VALVE STEM REBUILD($) <br /> FLAT REPAIR($) LOOSE DISMOUNT(S) ALLJGATOR CAP(S) <br /> REPAIR MATERIAL(S) TIRE(S)BALANCED METAL VALVE CAP(S) <br /> WHEEL-SWITCH(S) RECONDITIONED WHEELS) JV 0 RING(S) <br /> SI ;RxrG:z '''tsz b IPZlON7 ;•�•',F''nty.:..; _.r.;, FINISH MILES <br /> START MILES: <br /> TOTAL MILES: <br /> $TART TIME: A PM <br /> ON SITE TIME: AM PQM <br /> OUT TIME: AM <br /> LOkDAMOUNT a fi. �.,-.2:y y sr 'uA' I,r!k+t,+w.. <br /> FINISH TIM <br /> E <br /> .t <br /> Std ' '� �''` :�tf�ifJL 1G�i�$ i'"'+''n',ti ,,•.R. <br /> 0 GOVERNMENT D LEA EXEMPT 0 OTHER <br /> OAGRICULTURE <br /> 0 COMMON CARRIER/BACK HAUL <br /> PITDIPMMI" <br /> �„ f3Ap'r .,'"';; :": t:.: , k,tr•, dr= <br /> FROM OLE TIRE COUNT 0 WEIGHT IN POUNDS <br /> T To � VOLUME CUBIC YARDS 0 WEIGHT IN TONS <br /> yew' I certify that under penalty of parJur/under the I of the stele of California that the tntormatron provided strnv6 is true and correct.In?.demon,I <br /> a a ware that fatsfflGation of lhie information may result in clavi penalties up S25,W0 per day,per.V1014tion or adminlatrativa.Penalties up to <br /> a <br /> $5,000 pervioiationper day atda:cribedInPublic RCSaumesCodesection42962, <br /> CUSTOMER PRINT•NAME CUSTOMER SIGNATURE DR7E <br /> FSR No. 171498 <br /> PLEASE CIRCLE STORE LOCATION AT TOP <br />