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<br /> LAKM
<br /> ' ,01� 1572
<br /> Pickup Receipt Makup Date: 06/02/2026
<br /> ED'S' Manifest; 1101631672
<br /> JDT Trip Log: 569670
<br /> stare No: 03616
<br /> FIRESTONE TIMC;!
<br /> 940 CENTRRL AVE zokin Tire west
<br /> TRACX , CA 95376 13305 Spring Ave
<br /> PHUT : .209-221-7164 Santa re Spring-9, CA 90670
<br /> TPID: 1699854-o1 PHONS: 600-486-2752
<br /> TPT,.D: 1000659-01
<br /> Truck: 423468
<br /> Trailer: 2005
<br /> I,iCIIMS19 NUPbtr: 9F34829
<br /> Registration: 16-0.2315
<br /> State: CA
<br /> 1:Lem1 (tk�ole Tires)
<br /> Q'ty
<br /> Tires Picked TIp: 17Q
<br /> �i�,aturea pi 13a ,gr / mr- DRIVER: SCTELO, a0RW 1�
<br /> �I+I� ,,,•,,fl!1 '1 rw,. ,y ,r�1 •' I ccrtlry that unrJn,r rnamiary of ,Por)ury Lmdor th4 I,nwa Por n.11^ o"tnta
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<br /> Illi. r.••.1+-I' . tri edditj,oL, I nm awnq`r that. rnl.8ifi.cetion .,f chin ,InfnrnfaeS,on may
<br /> '1{�r�'�I11�Af 21I ke"'t 1,n eunlx+nnSen, soVoont;�,gn, •ar awnp,al of a;gnnl�al a1 tree wnrR�
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<br /> iii u ���I l Ir I I) 929.0 and may snnL+lc 9.n 06V;�l poaultl.
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<br /> C+EZNERATOR nNNST11
<br /> l I f��s,,:a',::�+I°,I��,'Ihr :i tilfI,'I:,I{,, 4,'i:lll�.ill,>iv�I;',Lo-,.,..a'.r.-•,irk;lL��hri1,l�°;� "J antkifY rl,41t. undax pehalty of t'
<br /> 7r pGy Wide: .
<br /> ha 1.Du:r of thn 9'haea
<br /> 4f, oallcn,I:.oiO thnt the in,fg11:` ,rivm P,rnviLhd abov< ie trues nqd
<br /> aerrn.r,.
<br /> � A Codfid�t-imJA.•Y' Claim: The 1J1XO=atian rovidP
<br /> considered confidential, P d de �h'�s form s1a<�u1d be
<br /> Title 19, CCR., Section "17091�At.eeq, s ouldand/oxarnyememberrof the aCIZpubOr ance with
<br /> o disclosure o.e th:ls infoxlpaticn, T reVeOt that CPI,1,Recycle contit,;t me at the
<br /> adQ,r.�:�� and te1r�ph-One numbtr abov,g•
<br /> Tl"CttOXaC aep=t9.ng to CalRf-'12701 e; Lakin T.�ze WgAt-- has been aut,hoxj.zed, by
<br /> calRocyc]_e tc Paxticipate 1n the Waste a,t�d Used, Tiro Manifest NDT QXectronic
<br /> repO,rting program. On be,h,alf 5f the cuatomer listed on 'thio farm, Lakim Tire
<br /> I�Tezt will e�Vctronical.ly 'transmit tO CalRecycle s,3,1 regui,sed in.fe;rMIRtion frgM
<br /> this mani.f,est,. CalRecycla has approv©d. the LAkin Tine D est EDT form for ume
<br /> within, the Waste Tire ManifeSl: System. EDT p,rogran.
<br /> Ple.Azo Contact your CU9t0M0,1:, Servi.cr^ pepresentative at 600-4£38-2752 ter email
<br /> custome,taervice@l.>ak t,n,tire.cCRd,
<br />
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