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CHANGE TIRE REQUEST FORM

GCC - 319 Rev 1 05/14/21

                           
UNIT: NBP 2779 DATE: JULY 20,2021  
DRIVER/ OPERATOR: MELVIN RODRIGUEZ CONTROL #:        
   
NO. BRANDING NO STATUS SIZE BRAND DATE ISSUED THREAD GAUGE REASON FOR REPLACEMENT
1 05 200727172 12.00 ANSU 07/27/2020 3MM BUSTED

Prepared By: Confirmed By: Validated By: Approved By:

  JP NORBE   G. DELA CRUZ         CMD  


      President & CEO

Carlos Hilado Ave, Circumferential Road., Brgy. Bata, Bacolod City, Negros Occidental 6110 Phillipines Tel. No.: +63-34-441-2409 to 10 Fax No.: +63-34-441.0693

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