West Texas Frac Sand Logistics, LLC - Termination Forms

• Trailer Received

• Last 6 of Vin#:

• Trailer Type:

  Select WTX Hopper TSS CIG PLG Chassis Misc.:

  • WTX Hopper
  • TSS
  • CIG
  • PLG
  • Chassis
  • Misc.:

• Other/Misc. Trailer Type:

  Leased Trailer

  Pneumatic

  End Dump

  Flatbed

• Conducted on:

  Date

• Prepared by

Driver/Contractor/Leasee Information

• Name:

• Unit#:

• Phone#:

• Company Name:

• Reason for Return:

• Leaving

• Transfer to Another Unit

• Delease

• Temporary Delease

• Absent Delease (driver not present)

Equipment Inspection:

• Trailer turned in/inspected by DOT/Safety?

  Yes

  No

  N/A

• Lights

  Pass

  Fail

  N/A

• Tires

  Pass

  Fail

  N/A

• Brakes

  Pass

  Fail

  N/A

• Frame

  Pass

  Fail

  N/A

• Notes:

• Please Photograph all (4) sides of Equipment

  Media

• Does the asset pass inspection?

  Yes

  No

  N/A

• Hopper Equipment Returned?

• Wiring Harness

  Yes

  No

  N/A

• Handle/Hand Crank

  Yes

  No

  N/A

DOT/Safety Checklist

• DOT/Safety Final Termination Checklist Items:

  Select Surrender Apportioned License Plate (Company Plates Only) Turn in Fuel Card Remove Decals Turn in Truck/Trailer Paperwork Meet with Alexis to sign final delease paperwork

  • Surrender Apportioned License Plate (Company Plates Only)
  • Turn in Fuel Card
  • Remove Decals
  • Turn in Truck/Trailer Paperwork
  • Meet with Alexis to sign final delease paperwork

• Signature of driver/contractor/leasee

  Sign

• Signature of company representative

  Sign

Termination Detail

• Date Terminated:

  Date

• Voluntary

• Involuntary

• Rehirable?

  Yes

  No

  N/A

• Reason for Termination:

• Copy of Contractor CDL/License/I.D.

• Fuel Card

  Collected

  Cancelled

• Fuel Card Last Used On:

  Date

• Fuel Card Cleared in System?

  Yes

  No

  N/A

• Decals Removed On?

  Date

Deductions/Statements:

• Equipment Statements:

• Recurring:

• Loans (Alex)

Truck/Trailer

• Trailer Received Form Collected?

  Yes

  No

  N/A

• Drop Off Site:

• Last 6 of VIN#:

• Verified by:

  Lucio Montoya

  Bryan Altamirano

  John Delgado

  Other

• Truck Paperwork

  Yes

  No

  N/A

• Apportioned Plate Surrendered

  Yes

  No

  N/A

• Refund Issued?

  Yes

  No

  N/A

• Trailer Paperwork

  Yes

  No

  N/A

• Termination Agreement

• Terminated By:

  Alex Trevino

  Alexis Trevino

  Bryan Altamirano

  Ivan Subia

• Termination Email Sent On:

  Date

• Termination Email Sent By:

• Added to Termination List?

  Yes

  No

  N/A

• Termed From IRP Account?

  Yes

  No

  N/A

• Please notate any items that are pending, required to complete prior to completion of the delease.

Equipment Terminated:

• Unit#1

• Make:

• Model:

• Vin#:

• Final Fuel Usage:

• Notes:

• Termination Completed By:

• The undersigned hereby acknowledges the lease agreement between West Texas Frac Sand Logistics, LLC (carrier) and the contractor by the signatures affixed below, declare the lease of the equipment identified here is terminated as of the recorded date.

• Contractor Signature

  Sign

• Carrier Representative Signature

  Sign
Equipment Terminated:

• Unit #1

• Make:

• Model:

• Vin#:

Additional Equipment Terminated:

• Unit #2

• Make:

• Model:

• Vin#:

Additional Equipment Terminated:

• Unit #3

• Make:

• Model:

• Vin#:

Additional Equipment Terminated:

• Unit #4

• Make:

• Model:

• Vin#: