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22-OCT-2014 14:04 From: . 2095551�2/112► To:83'-�83 Paee:3/5 <br /> WILSON WAY TIRE CID, INC. FLEET SERVICE RECORD 0q114# <br /> U.S. TIRE SALES <br /> TM 1000837 17 4 9 3 1 <br /> so Vft&M my Tfia *Vow way Tfre Reap 402 CawcN rine It"u5 r"Sales on us The Solas #24 us rtre ssfaa <br /> 221 N.W1kon my 1=Mike!SL 229.9 N.mon M4y 2W 1b86mffe tllftrd 7995 AbVh al Ave. 6590 FramtWn Wind <br /> Stockton,PA B520S St0e:*166,CA 95205 SYocktork CA 95x0$ Modest%QA 95261 KAYWW4 CA 91415 IWMMOM to,CA 9UU <br /> 20P466.0259 202-a$4 82 ""a-1282 11164196 2215 <br /> ACUSNASR P., a DATE _ <br /> NE VEHKXE <br /> IIi <br /> • LK�IV <br /> LOCATION OF E . STATE ZIP CODE <br /> CLIWOMER TPID —� <br /> ' � � i DECAL � <br /> ty seat under penalty bf plyWy undw ttfe Iaws a!Hr!Stale d t�lHomla flea!the trefornutttnm <br /> pro:.d4d above Is true and cerracf.in addtltan,t atm•yr7+4 lllyt 4ieiflcatlom of <br /> thm k&ffi*ion rreay result In susP4naWn,rwawthmp or der"of minsw;$of the Waste Tire#aider RctomwNan pumvent to Publh Reaoluces coda seeton 42m And MPy <br /> result in owu pond s up to 525,080 Per day"per violation of a"nWfratfve PeoWgs up to SU00 per Ylakdon per day as desamtyit in Pubft Resotaces Code seedoo 47862. <br /> DRIVER DRIVER 3iGN11 T <br /> x ,1'`,i •b .Ill=: <br /> MAKE uTRUCtCftRN R# LLMENSE STATE ODOMETE"UB <br /> S • 1 grMUC,qwsi CN: OFF' <br /> L C oll I - <br /> • <br /> IOU u* <br /> F w Is ILA <br /> weKxrOF wOtic co rm_ �ri ` n rfat ox.Ivoim rm <br /> SERWICALL MOUNT!PISMOUNT(S)ON VEHICLE BRASS VALVE STEM(S) <br /> FLEET INSPECTION VAMN I IISMOUNT(S)LOOSE ALUMINUM STEM(S) <br /> AIR SERVICE LOOSE MOUNT(S) VALVE STEM REBUILD($) <br /> FLAT REPAIR(S) LOOSE DISMOUNTS) ALLIGATOR CAP(S) <br /> REPAIR MATERIALS) TIRE(S)G ALANCED METAL VALVE CAP(S) <br /> WHEEL SWITCH($) RECONDITIONED WHEELS) O RING(S) <br /> QTY UFO t7ESCR!P17ON FlNISH MILES: <br /> START MILES- <br /> 3 <br /> TOTAL MILES: <br /> START TIM AM <br /> ON SITE TIME: PM <br /> OUT TIME: AM PM <br /> FINISH TAHE:�,�A., PM <br /> LOAD AMOUNT )P <br /> HAULER EXEMIaTI'M WA—PPLIE; Le <br /> Q GOVERNMENT Q LEA EXEMPT Q OTHER <br /> —— «— Q AGRICULTURE Q COMMON CARRIEMACK HAUL <br /> PICK UPLdAy E'• <br /> ❑ IMPORT FROM S:•,-i OLE TIRE COUNT <br /> �,:�ELNERY ❑WEIGHT IN POUNDS <br /> t d maaoRTio ^'�, ,,+ OLUME CUBIC YARDS <br /> L3 WEIGHT IN TONS <br /> ._� <br /> a:SQ I canNy drat wW3r penahy at perjwy under the of the state at CalNornto tmt thr htforu m tion provided above Is true and emrecL In addmoe,I <br /> �o� am aware deet Patsi6oayem pt,==Ban Ban mLft In eAril penaltes uP MOW poi day,per vk4ahlw or adminiesbativa penaNne up to <br /> L, :5,000 pervlotatam ptr ft es described in Public Resources Codi mcum 42882 <br /> CUSTOMER PRINT NAME CUSTOMER SIGNATURE DATE <br /> FSR No. .1 <br /> Q PLEASE CIRCLE STORE LOCATION AT TOP <br />