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11111 <br /> lip <br /> 1 32b16 <br /> Pi.C3tt3p Receipt Pickup nate: 12/28/2015 <br /> IDT Manif®st: 1101532616 <br /> TAT TrXp Log: 549266 <br /> Stom No: 036,75 <br /> 4x, nA IIs® Tam <br /> FIRESTONE TRACY Lakin Tiro UTest <br /> 940 CENTRAJ, AVE 15305 Spring ,7;ve <br /> TRACY , chi 95576 Santa Fe springs, rA 90670 <br /> 209/221-7164 TPID: 1000659-01 <br /> T'PTll: J,694854-01, <br /> Truck: 423469 <br /> Trailer: 26681 <br /> Licenso hTumber: 9F34829 <br /> Reg.l Itration: 16-023!5 <br /> 5't9tg,, CA <br /> T're+nt Qty <br /> T?,tea Pic):ed Tip: 103 <br /> si a• _ �__o:E Hauler l ��a�ar <br /> 1 <br /> It <br /> II <br /> ;.I IR, <br /> COXXidentiality Glai.m: The .information prc«tided on t.h,�s ;Corm should be �Data <br /> can.©j.dgr.Ad confidential, proprietary, and/'or 'trade secret, T.n jecordsnca w1.t)] p0 Af� <br /> Tit.lo 1,4, CCR, Section 17041 et_seq, should any member of the public znqueut +.ti <br /> disclo©uie of +:17ts ir_fozrnation, 2 request that calRecycle contact me at the <br /> addrett and tolPpho,ne number above. 7a' <br /> Vlk. ct,v0r,lc P"P6rting to Ga1R-n�ole: Lakin Tice West ha3 been authorized k:X <br /> C61Aecycl.e to p&rticipate in the Waste and. Used Tire Manifest EDT Pj autronic <br /> reporting PrOg,rarn. on behalf of the Qvstoarer listed on this form, Lakin rise- <br /> %2?St will al,nctronically transmit to cal Recycle all, required i.rriformation f.roM <br /> thtS mj1,r,,,ifeot. cal,Recycle has approved the Lakin Tire W09t EDT form £or usr <br /> within Che Waste Tiro Manifest System EDT program. <br /> Questions? Please conCact your ciastomer Sel:*Ace pepxesenrative At 000--966-•2752 or email <br /> customerser•Jico@1a�a.ntirc.c:o>•n. <br />