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`. REMIT TO: P> PO Box 910530• Denyer,CO 80291-0530 <br /> INVOICE DATE CUST.NO, ORDER NO. PAGE INVOICE NO. <br /> TIRES&SERVICE <br /> 07/10/14 194845 32230 1 855-30100 <br /> GCR 350325 STOCKT C855TTC <br /> 4336 POCK LANE SUITE 200 <br /> SOLD STOCKTONr CA 9206 <br /> SHIP <br /> TO (209)983-9495 <br /> TT,ax Id: PERU IL 61354-2859 US <br /> CIRCLE TRANSPORT INC ADAM FOR SIERRA CHEMICAL <br /> 315 FIFTH STREET STKN YARD <br /> PERU, !I= CALLED 1N BY jUAN <br /> PURCHASE ORDER NO. SALES PERSON PHONE SHIP VIA <br /> ITEM NO. DESCRIPTION CITY.ORDERED QTY.SHIPPED F.E.TC " e NET EXTENSION <br /> 4099 209-983-8298 DELIVER <br /> 388FTRC BD 111122.5 FCR TRAILER 1 1 me 24.61 134.61 <br /> VSTK SV VALVE STEM - TRUCK 1 1 7.012 7.00 <br /> AL V2B INFLATE THRU CAP (ALLIGATOR) 1 1 1.52 1.50 <br /> HRTK SV HOURLY RATE -- TRUCK 1.00 1.00 93.02 93.00 <br /> TD SCRAP DISPOSAL CHARGE 1 1 8.02 8.00 <br /> *TRL 125 LIC--TE3508 ID <br /> *RFI LARGE INJURY/IMPACT <br /> *06/27/14 <br /> TPID# 1099876-01 (TDS#) <br /> CHK'D BY: DELV'D <br /> Cuj3Ipmer authorizes com(1r?)y to�g orm the above written services to their vehide. <br /> SEE IDN STAT£�114dT1� REVERSE SIDE REGARDING CONSUMER CREDIT CONTRACT AND SECURITY AGREEMENT SubTot Parts: 151. 11 <br /> SubTot Labor: 93.00 <br /> XNet 10th Prox <br /> PRINT NAME/AUTHORIZED SIGNATURE <br /> NOTE: In order to save all FINANCE CHARGES,the customer must pay,In full,the entire unpaid ba'ance by the 10th of the following <br /> ' month.FINANCE CHARGES are computed on amounts 30 days or more past due at the PERIODIC RATE of 1.5%PER MONTH <br /> (MINIMUM CHARGE OF$1.00)which is an ANNUAL PERCENTAGE RATE OF 18%.The above credit terms have been set out <br /> in accord with the Truth-In-Lending requirements of the Federal Government and are for the customer's benefit and protection. <br /> PAY FROM THIS INVOICE <br /> PO# <br /> Date Delivered: Disposition of Take Off Tires: Your wheel components have been inspected <br /> Fleet Authorization # _Ret d w/Driver _Ret'd w/Dealer and it has been determined your wheel components <br /> Credit Release# _Ret'd to Customer _Ret'd for Warranty require immediate attention. <br /> Phone: <br /> Customer/Fleet Acct# Tire Replacement Reason A wheel assembly has been installed. Industry <br /> Customer/Fleet Loc# <br /> guidelines require that the torque level of the <br /> wheel nuts be rechecked between 50 and 100 <br /> Vehicle Information: For ERS Information Only: miles of operation and retorqued as necessary. <br /> Hubometer ERS Work Order# Failure to do so may result in loss of this assembly. <br /> Make Odometer DOT On Tires I acknowledge receipt of wheel assembly info. <br /> Model Color DOT Off Tires <br /> Vehicle# Lic#/State <br /> Trailer# Chassis# Driver Roll Time (Signature) <br /> Tire/Wheel Pos: <br /> Container# Serial/VIN# <br /> (Name Printed) <br /> FILE <br />