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May, 17, 2010 10. 51AM WI J WAY TIRE CO, 209 242-3051 No. 8898 P. 1/2 <br /> WILSON w rrR >w:; rrvc.. �. T E �E �Oo <br /> Qp� U.S.' TIRE SALES <br /> TOO 1000831.';1 <br /> !01 wAson Way nm INlhtoq Wiy mg Recap #02 tonne!!Tina f:Y1 US A*S�ihis #23 VS 71r9tel"el" �. >M US 7W Sales <br /> I21 N.Mhos Way fs9s MariEot St. 2211 N.W1non Wry Pw Y0awme Blvd 1911 NadarNf Ave ::.66301§iZin a" <br /> ;Nckton,CA 95205 St»ckft",.cx 95M Stockton,CA 95208 (lualeam,CA 9SJS1 Hayward,:CA 9640 swm tt)nfo,CA 96829 <br /> 308186-0?81 20.9406.3202 209�E�2681 4096 9-bb11. 610587;1Y8�:. � ' 916-SM22-95 <br /> ;USTOME P.O .: DATE4. <br /> PHONE, VEHICLEtn <br /> v <br /> 7 <br /> 1 <br /> LICENSE# T - <br /> -OCATIONOF SERVICE STAT ' ZtP CODE <br /> 0*111A <br /> LA <br /> CUSTOMER TPID 1 —�J'` DECAL,tE �— <br /> I eff"thtR Under penalty of pedury under the laws of the Stafs of cAftmlp tud me*- provldad ADovs is true and eemset InRldl--++t--"lm,I em eWon thol rauNkatton,of <br /> this InfbnnNon may result In suopenelnn,mistsHon,or dental of rensuM of tt4 Waste:Me.Nwler RegWiretion pwsunR to Publk Resources Code seotton 42M and may <br /> teauR to oW penahke up to WOO per dry,per vl*Won of admielstmWe penalties upb$6,000 per vlelatbn per day as desodbed In Pubue Rumms Code section 42002. <br /> DRIVERPNE DRIVERSIG DATE <br /> X <br /> MAKE TRUCKlTRAILER# LICENSE STATE pDOMETtiRMUB <br /> �LAL C-1t) -� 4 . 0 <br /> ;sac <br /> Imummmum IN MIUM <br /> SERVICE CALL I 'MOUNT I DISMOUNTS)ON VEHICLE_ BRASS VALVE StF_M(S) <br /> FLEET INSPECTION MOUNT/DIRIMOUNT'(S)LOOSE ALUMINUM STEA(S) <br /> AIR SERVICE LOOSE MOUNT(S) VALVE S'f>;M RESUILD(S) <br /> FLAT REPAIR(S) LOOSE DISMOONT(S) ALLIGATOR CAP(S) — <br /> REPAIR MATERIAL(S) TIRE(S)BALANCED — I METAL VALVE CAPS) <br /> WHEEL SWITOH(S) RECONDITIONED WHEEL(S) O RING(S) <br /> FINISH MILE8!. <br /> START MILES:, <br /> V3 ' 777 <br /> TOTAL MILEOf <br /> S: <br /> —1 -- - START TIM£; / <br /> ON SIT£TIME: AM PM <br /> F <br /> OUT TIME; , AM PM <br /> --- – FINISH TIME; AM <br /> LOAD AMOUNT t <br /> ❑GOVERNMENT Q LEA�fEMPT ❑OTHER <br /> Q AGRICULTURE Ll COMMON-CF RIE CK HAUL t <br /> PICK UP ✓��r rim &U , <br /> � L7 IKlPORTFROM.� WHOLE TIRE FOUNT ' ❑WEIGHT IN POUNDS <br /> DELIVl=RY -: <br /> O EXPORT TO ❑VOLUME CUBIC YARDS ❑WEIGHT IN TONS <br /> c oQt, I car*tint under penalty of per3uty urrior tt,.I of th `8t to d CarMomle thai the irdonnatton proWded abM Ia trRe and correct 1n additlon I <br /> em aware that ialelAaetlon of title Information may rrauk rn dMr peMMNn'up.S28,000 per dry,per rfulaHotl or tnlsvativrr penmltlas up <br /> alID0pervlolabonperdeyapdascribodinPubll0R*vQ%Ir**4Codee 3$52, <br /> CUSTCHIAER NT NATtfE t fGt1t1ToirolkwTL65PA <br /> FSR No:. 145 6 9 8 PI FAR 140 t^ 'itS12 ,f:heiATlnty AT TnP s <br />