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CA 7W <br /> 1 0149 _2 . <br /> Pickup Receipt -�" <br /> Dat.C: 10/29120.15 <br /> MDT Mzvti-fo a•t: 1101497221 <br /> EIIT Tr„g,D Log: 538944 <br /> SI:ore MC: 03W6 <br /> FIRESTONE TP.Ac-f AUS I OX And Find 1 ac± Eaoj 7 i ty <br /> 940 cENTRAL AV-.F Lakin Tire West <br /> TRACY , CA 9337Ei 15?05 Spring Ave <br /> 209/2„'x,1-7169 Santa Fe Springs, CA 90670 <br /> TPID: 1699659-0]. TPID: 1000659-01 <br /> Truck: 923468 <br /> Trailer: 53790 <br /> Licitrnse Nvmbor: 9F39629 <br /> Registration: 15-06936 <br /> State: CA <br /> z t� <br /> 1'-iYe9 Picked Up: Qtylyl <br /> I•fl , ;lii��l�iiii,l�v'�!f!, f' •�I�li�:�;t"I i)�6Gr�� <br /> I, i,���' 'll<I ;;�,i,II r��i�l'.'�i; ; t �•i';f ��� �r <br /> >)11 '•� f. Ill, i l l� i�. <br /> 5 i1!fl qyJuq <br /> i, •2i;�:,�.. li:Iv, f',I°" q,f •nf fdC.:�iy�iiL:: <br /> �l ;..•.1 i,Irk Itil�ll'li iY IJ�?��l�1�I{� li�Ill�!�I:�ii• <br /> j it il� I'I�?�.: � t :f �II f 'I'- r':•h <br /> Cvnf LdentzLal.ity ClabU.- The information PrOvidsd on zhia form should be <br /> considered confidential, proprietfIry, Qhd/or trade seereyt. In aeoordanct with G DarQ <br /> Title ].9, CCP., Section 17091 Rt.rreq, should an , mQraber of the p q `5"' <br /> disclosure of this information >1b]is re u�st 1Q 'r <br /> 1 request that CaLlRecyc7,e contact me at the 4 <br /> a:ddr-esy and telephone nunbtr above. d <br /> S� ti <br /> L1P-0tronic RaPa,xting to Cu1Req„QI*, ,Lakin Tire Woot has bwen authorized by <br /> CalP'ecyCa;le to Participate in the Wasto aZd Used Tize .Manifest EDT electronic <br /> reportinq progXam. On h*htalf of the cuzitomer lilted ora th-n fQ=, Lakin Tire <br /> West wiJ,I electronically transmit to CalRecyr_lz all rfzcTuired informatiap,, from <br /> this ma,hifest, CalRecycle has 1pproved the Lakirl Tire We St EDT fo,sm for use <br /> within the mastu Tire Mnnifeat Sy--tem EDT program. <br /> Qu"bstiODA? please contact youz Customer SeZIrice Representative a,t 6'00-48e-�75Z or ernaA.1 <br /> cu8'C ome r.3 exvi ce @ 1 a k i,n t i re.coA_ <br />