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JAN-27-2011 11:30 From:ACECOMPANY 2099220235 To'P-0946E2392 P. <br /> WILSCMAY TIRE. CO., INC. FLEET SERVICE RECORD <br /> U.S. TIRE SALES TPID 1000837. 14 O O E 3 <br /> 001 Wilson Way Tire. Wilson Way Tire Recap iloZ Connell Tiro 421 US Tiro S:drs 023 US Tire Solcy #24 US Tiro Sa/rs <br /> 221 M Wlllon Way 1535 Market St. 2211 N.Wilson Way 2600 yosemite Blvd 1015 National Ave. 6590 FearrAlm 81vd, <br /> Slockfon,CA 95205 Sfockfon,GA 95205 5fockton,GA 9x205 Modesto,CA 95354 Heyward,CA.44545 Sacramento,CA 95823 <br /> 209.465.0201 209-465.3262 209-466-2501 510.867.1262 916.395-2245 <br /> GUuTOMrR (O PO.# DATE <br /> PHONE VhHICI_E d <br /> LICtN3E tf <br /> LOCA I ION OF SERVICE /-- I Aa: <br /> S I A I E � ZI CODC <br /> rr Vq 0 Am <br /> CUSTOMER TPIDI d DECAL# n 50.ej. <br /> 1 Certify that under penalty of perjNry candor the laws of the State of California tlral Ihv information provided above Is true and rorrnrt In addition,1 ant aware that falsification of <br /> (1)if,,ntormation may result In suvponaion,ravouati0nt,or denial of renewal of the Waste The Hauler Rwyisb.',h rn pursuant to Public Rolloureas Code section 42060 rind miry <br /> rosplt in civil penalties up to(25,000 ptr day,per vloladnn of administrative penalties up to$5,000 par violation per&Vrix rincr.ibod in Public Resources Coda section 42962. <br /> DRIVER NAME DRIVER SIGNATURC DATE <br /> X ...> <br /> 1dAK TRUCK/TRAILER 0 LICEN3C STATE r)DOMt'1 t:RjHI,lk <br /> ill-AlL INSTRUCTI NS , ON OFF <br /> 0TY DESCRIPTION OF WOkK COMPI ETF.D 07Y. DESCRIPTION OF WORK COMPLETED OTY DFSC'RIPTION OF WORK COMPLETED <br /> -...... __ —..... w... .... ............... <br /> SERVICE CAI_I_D N10UNT/DISMOUNT($)ON VEHICLE BRASS VALVE S I LM(S) <br /> Fi„FFT INSPECT I ION MOUNT/DISMOUNT(.;)100,5E ALUMINUM STEM($) <br /> AIR SERVICE LOOSE MOUNT(S) VALVE STEM REBUILD(S) <br /> FLAT'HEPAIIl(S) LOOSE DISMOUNTS) ALLIGATOR CAP(S) <br /> F,EPAIR MATERIAL(8) TIRF(5)RAI ANL'HU METAL VALVE CAP( ) <br /> EEL SWITCH(;) RECONDI I IUNLU WHEEL(S) O RING(S) <br /> QTY. SIZE MIrG DESCRIPTION FIN12iH MII FS <br /> :iTAftl' <br /> -- <br /> TOTAL MILE <br /> r$TARI TIME. <br /> tlN,41TF TIMF -i.i"nnq Pm <br /> UUI IIMt. ':!SAM PM <br /> FIN1311 TIME AM I'M <br /> LOAD AMOUNT HAULER EXEMPTION IF APPLICABLE <br /> _..._...._ l..a <br /> ❑GOVERNMENT ❑ LEA EXEMPT ❑OTHER <br /> J AGRICULTURE G COMMON CARRIER/BACK HA(Jl <br /> ICK UP o LOAD TYPE <br /> WHOLE TIRE COUNT ❑WLIUHT IN POUNDS <br /> [j DELIVERY <br /> EXPORT TO , J/ J VOLUME CUBIC YARDS _J WEICI-IT IN TONS <br /> cren;ty that undar partially of perjury under the lewv of the State of California Ilial tium irdonnaliurt ptovlaea above i6 true and correct.In addition,I <br /> op T� artt aWafe that fifl-0iralinn of Ilii% into matiun may result in civil penalties up$25.000 per day, per violation or adminigfrativo ppnalfir,. up 10 <br /> 4 Qp $6,u00poTviolation per eyAa escribe InPubllcResotrreesCodo-ncfiona2962. X0 <br /> p n n CUSTOMER PRIN AMC CUSTOMER SIG UR[ DATE <br /> FSRNo. 1 ,4 l 11 ' f; ' A e'I- F- r,Tr,%r-ir– I r%r,n trnn i -r r.,r� <br />