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(A All <br /> 1014 373 <br /> Pickup Receipt "'QkV Date: 11/01/2015 <br /> 10T Manifest: 1102,497373 <br /> XDT Trip Log: 540925 <br /> atom NO: 036J'6 <br /> _Q�I1Q�C'A.'hnr <br /> IIP,E:'3TONE TFAcy <br /> 940 CENTRAL %vE Lakin Tire West <br /> TRACY , Q, 95376 15305 Spring Ave <br /> 209/222-7164 Santa Fe S9ring3, CA 9()670 <br /> TPID: 1694H4-0j, 711ID: 1000659,01 <br /> Truck: 923468 <br /> Trailer: 53281 <br /> Lia Number: 9F3982S <br /> Pegi-$trati.on: 15-06936 <br /> State; CA <br /> Item <br /> ?Tires Picked up_ <br /> +17.1') <br /> I: i . 111J I I� ' .II lliljl�uilil�l'�s, <br /> . . <br /> 7,1I Ifl�llw �`j�Illlll�°tJIN} liilj: <br /> Confidentiality �aamt The i.Tlformatign 'Drova.ded on t <br /> eon�idered, confidegtial hid t, I should be <br /> 041 aletax'y, and/or 'l'sade 9i9Cret. 2n adcordancly with <br /> Title 19 CCR, section 27091 e, I r should any membsar of the public ,equest <br /> disclosl.ires o£ this i)1t£oxit:a�ion, T za�cPlest that Caa,Rel le c�anact mp at <br /> t , <br /> address ,and telephone number abovs,. QCi <br /> Elecl:ror►ic <br /> Aort3ng 'to Cn�aycle: Lakin Tire Wes L' tlas been. author' <br /> M,�d by <br /> Ca1RQCyrle tO ps�rti.cipate in the Waste and Used `z'ire Manife.4t EAT electronic <br /> ZePOz"t:ing PrCg4aam. on behmlf of the cu8tomer listed on thin .form, 51,ecth.Ln Tire <br /> F7e3'C Will electronica,Y1.y tranQ�t to CalRecycj.0 bill zequired form, <br /> lnatipn Prom <br /> thi2l uhanife0t. Ca],AeCycle has approved t,l_.e La Tire quiWa�id i form Fcr use <br /> wirlun theVGn2te T;i,re Ma,nifost syst= F1DT prcgram_ <br /> CU-si iti rza PeAneice@j Contact �rOUC Cu9tommr SerV�.tcn Repre�,mnt_ative at 800-988-2752 or emd;il <br /> cu,�,tomorse;rvri ce@L�,hlnti xe.Coln. <br /> ■ <br /> ■ <br /> ■ <br /> ■ <br />