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F(CA AM
<br /> 11015878
<br /> Pickup Receipt PxohuP AAt0-- 03/22/2016
<br /> MT Mar-ir nlli0't: 1101567849
<br /> SLIT Trip Tagg; 559963
<br /> Store '50: 036J6
<br /> F1RETRACY
<br /> 940 CENTRAL AVE Lakin Tice west
<br /> TRACY , CA 95376 15305 spring Ave
<br /> PHONE; 209-221-7161 Santa To Springs, CA 90670
<br /> TPIb: 16944$4.-01 PHONE: 800-488-2752
<br /> Tpzn: 1000659-01
<br /> Truck: 423468
<br /> Tred,rler: $3792 j
<br /> Licentle Number: X1'34829
<br /> Registration: 16-02345
<br /> State: CA
<br /> z an (Whole =Xe(l)
<br /> Qty'
<br /> Ti,.rc;s picked U�1p l3F
<br /> �t 15' gp=Spr�A+ DRIVER: GOr. ELO, JORtl ,N
<br /> .1 certify r,4n: und6r nennit'+ ne
<br /> t 1 Y MyVjklty vndnr. the laws of ).he $tot,
<br /> o£ ealirn,rilia that, the informnr_;,on provl.A144 4bcmc is t.ru? and .effect_.
<br /> 1� r'' Ir I. i:•
<br /> h r I .yi1(I.I`r' t C 11 � t eppi flt nddisicxi, f em nwarn rhdr� :elaiil.cnticm �,f,
<br /> 1 l - U .i. ,' in� •EI1l.S in Formation play
<br /> r n"' env1C d,e nurpm.-.icn. cnoQoatlOn. r�.r daninl of ,Il nitw
<br /> "ire Naulnp RMriatrot * Mor thn ware
<br /> lan oureuanf, p0 Public ng. er'ctian
<br /> F 1r I'ij 12?GD n A 25.DO Wont,
<br /> .fi'•,!, 'I'IIJI,!° I I�ir�(Illn. violat:i..�rr oryedm9t11,1. in civh L�4hetltielm vF to :25,UOn pef dny, par
<br /> .7lrncivo r
<br /> d1 ee doacrlbn n^.nnlcq o dl g0 Jim 429U.r r
<br /> Y d ia1 Fublir_ Reaourc c d 6ccticn Ata vl.nl.aCion
<br /> V�If htl,.,
<br /> GRTZ ATOR: JAMS GLAZE
<br /> "T ues,Lsiy thAr, undernrn
<br /> eh!.rlr.;Yil;.dl .lein;ll,l, . oP en.LSfaCnie
<br /> that r.hpAin£6smnOJfppodr]
<br /> aptovlgder r. 11c lawn of l;He State
<br /> energo4." Above in -.r,re nrd
<br /> C i t��.1 ity Cla i fns The i,T'form,3ta Qn rov,
<br /> �. P iC18d on thin �'oxm should be
<br /> Considered confidential, proprim'1.'Ary, and/or trade stCxat. Yn a=ordance with
<br /> ^koor� Title 14, CCR, Soct4on 17041 et.,aggr shogld any rmembmi of the blic
<br /> r di,sclosurn of this inloamaticl,R, T re , equest
<br /> address and. telephone quest that CalRecycle contact me At the
<br /> P cine number above.
<br /> XLectronia Reporting to Ca1Rt,t:"rcle Lakin Ti,tla West hese been aut,I2otized, by
<br /> Cs�,J.Recyclo to PRrtiCiPate in, the waste a-ad Used Tire Manifest EDT eleo'tronic
<br /> "Porting Program. 0n behalf of the cuatcmax lipted, on this form, Lakin T:Jre
<br /> West will ele-A4;:t_ronica14y tran,AMj t to Cal,Recyale s,ll requixgd information krcm
<br /> this manifest. CR1Recyclg ha.s &PPt.'oved the Lakin Ti.te west ,
<br /> within the Wa.yte %re Manifest system MDT Form Zor, usEi EAT prot�xam.
<br /> Queel:i,gh,3? P1nane aka,ntil"g contact ycol.i•,' Customtmx ServIOM ,Representative nt 800-408-2752 <).r email
<br /> cu9tomer.,erv9.cef�.l ,ccmi,
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