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CI <br /> 11 z-A- <br /> 2 <br /> Pickup Receipt Plckgp Date: 12/15/2.015 <br /> 13DT west: 11O1525263 <br /> RDT TX:Lp Tog: 547312 <br /> StorA ro: 036,76 <br /> sa .r.gto - Ant�lte,Q TaaaiLLty <br /> FIRE$TONS TRACY Lakin Tire TR29t <br /> 940 CENTP.A,T., NVE 15305 Sprzn.q Aire <br /> TRACY , CA 95375 Santa Fe Sprinan, Cly. 90670 <br /> 209/221-7154 TPIn: 100065901 <br /> TPID: 1694954-01 <br /> Truck: 4.23468 <br /> Trni9,e.r: 54079 <br /> Licenc© Number: 9FS4829 <br /> Registration: 16-0234: <br /> State: CA <br /> TtM - Qty <br /> Thea Picked Up: 114 <br /> RJ Tires: 5 <br /> �QS,ldt•ZL@a ti.�w K.a�r� � .n�ltrr�t-nr <br /> .a..,.r.... <br /> .., <br /> .,..c_•I EY!;j'J'I'�� I`�I II,'i,�i ") I•' ?;i�t'�=��Zi',�' <br /> r[h, �";��+ijCl (� loll� )( �' �If}I• °l;�:r�i:ii;;.: <br /> �.= ,.. .''141 �U,,` '•�� �i 7� �,:,,��;,., <br /> �'"•li)li�)��ial�i" '��I'v!�lil'I'It'!;4"��" '.,Oi`,<IIiF •.i- •:?: <br /> Cou£•identiallty Claim: The :O-fOrmatid3n prcrvidAd on thin fo,T,m should .bs <br /> considered confidott9,a1, px-opzietaryy andlor trade -?fret. In accordance with �'�, <br /> Title 14, CCR, Section 1l0�7, et.seq, ahould any member of the public request G V <br /> disclobu,re of chj.n j.nfoznpj,;.ton, I request that CalRe'cycl,c contact me at the <br /> adds,es 3 and te.Iephone ruribelr above. ti <br /> Electronic kWpvrting to Ca AeCyale: Lakin Tire went has bn4m authorized by <br /> CalRecycle to participato in the Waste 4ndl Used Tj,re Manifnnt .EDT ©lactroric <br /> .reporting program. On ,behalf of the Customez 1iotsd OXX this form, Lakin Tire <br /> wnsi: clect,rcnically transmit to Ca1RcCVCle ali z'aqujrad Information from <br /> this Cn.ITR cycle tia: approv6d the Lakin Tire V7n t EDT foam foz u,Mr <br /> within, the Wastt Tire Kang f'.egt SystfTh EDT program_ <br /> puentions? Please contact your Customer Service RepresontAtive at 800-188-2752 ar email <br /> customeraezvicc@lakivtire.con, <br />