B l k . 7 , L o t 3 , S o l i d S t .

, L a g u n a I n t e r n a t i o n a l I n d u s t r i a l P a r k

(L IIP )

B rg y . M a m p l a s a n , B i n a n , L a g u n a 4 0 2 4

T e l . N o . : (0 4 9 ) 8 3 8 -3 8 8 8 T e l e fa x (0 2 ) 5 2 0 -8 4 5 6

T IR E C L A IM E V A L U A T IO N F O R M

D a te : Ja n u a ry 1 6 , 2 0 2 4 C la im s N u m b e r :

N am e : T h re e J S to re C o n ta c t N u m b e r s :

A d d res s :

D a te
R ef D o c : R e f C r e d it M e m o : C M -0 9 5 1 -2 3
A R -9 5 1 -2 3 R e tu r n e d :

T IR E IN F O R M A T IO N D E T A IL S:

D e s c r ip tio n : S A I L U N 2 6 5 /5 0 R 2 0 X L 1 1 1 T T E R R A M A X A /T
S e r ia l N u m b e r : D O T N u m b er :

O r ig in a l T r e a d D e p th ( O T D ) m m : 10 R e m a in in g T r e a d D e p th ( R T D ) m m : P e r c e n ta g e : 0%

L o c a ti o n o f F a i l u r e :

□ C ro w n / S i d e w a l l / S h o u l d e r □ B e a d / W i re / H e e l □ C a rc a s s / L i n e r / F l a n g e

D i ffe r e n t T y p e o f F a i l u r e s :

□ S id e w a ll C u t □ F o re i g n M a t t e r

□ Z i p p e r B re a k □ U B la ste r / S te e l O u t

□ S e p a ra t i o n □ G ro o v e C ra c k i n g

□ S p lic e □ C h ip p in g C h u n k in g

□ E x p o s e d C o rd s □ D e fo rm a t i o n

□ C ra c k i n g □ T ra n s p o rt D a m a g e

□ D e la m in a tio n □ Im p a c t B re a k / C B U

□ B u b b le □ B u rn e d B e a d

□ B u lg e / Jo in t □ B e a d B u rs t

□ P i n H o l e (A i r L e a k ) □ P u n c t u re

□ T h in L in e r □ O t h e rs

P o ssib le R e a so n / D u e T o :

□ R o a d H a z z a rd / O b s t a c l e □ U n d e r In fl a t i o n / O v e rl o a d i n g

□ M o u n tin g D a m a g e □ E x t e rn a l D a m a g e / In j u ry

□ M isa p p lic a tio n □ U neven W ear

□ A l i g n m e n t P ro b l e m □ T ra p p e d S t o n e

□ F a u l t y M e c h a n i c a l / U n d e rc h a s s i s □ R e p a i r F a i l u re

O th e r P o s s i b l e T y p e o f P r o b l e m :

□ D O T O v e rd u e □ O t h e rs _

□ R u n n in g F la t ________________________

E V A L U A T IO N R E SU L T :

□ C o m p e n s a te □ F o r F u r th e r E v a lu a tio n

□ R e je c te d □ O th e r s _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

R E M A R K S: Prep ared b y : D e b e jo y L L la v e r

I n s p e c te d b y : H o w a r d X u / T e c h n ic a l M a n a g e r
P O S S IB L E C A U S E :
N o te d b y :
S id e w a ll C u t: s id e w a ll p ie rc e d b y s h a rp o b je c ts ,s c ra tc h e s , o r
C u s to m e r C o n f o r m e :
c a u s e b e lt,c a rc a s s p ly is d is c o n n e c te d ,d e la m in a tio n ,s e rio u s ly
________________________________
c a u s e tire b u rs t.
P r in te d N a m e o v e r S ig n a tu r e / D a te

* O r ig in a l - C u s to m e r * D u p lic a te - L u x u r ia n t * T r ip lic a te - D e a le r