Laserfiche WebLink
Pickup Receipt 9/17/13 12;18:00 PN Pickup Receipt 8/20/13 11:3 <br /> Lakin Tire-Stockton EDT Manifest S 1101005324 Lakin Tire-Stockton EDT Manifest*2085047 <br /> 15305 Spring Ave EDT Trip Log *446852 15305 Spring Ave EDT Trip Log *443456 <br /> Santa Fe Springs,CA 90670 Store: FW00212 Santa Fe Springs,CA 90670 Store: FW00212 <br /> 562-802-2752 Driver: JORGE SOTELO 562-802-2752 Driver: JORGE SOTELO <br /> Hauler and End Use Facility Route: ROUTE48 Hauler and End Use Facility Route: ROUTE48 <br /> Truck: 334637/State: CA/9D97640 Truck: 334637/State: CA/9D976 <br /> Decal: 13-03886 Decal: 13-038% <br /> Bill To: Ship To: Bill To: Ship To: <br /> FOUR WHEEL PARTS STOCKTON FOUR WHEEL PARTS STOCKTON FOUR WHEEL PARTS STOCKTON FOUR WHEEL PARTS STOCKTON <br /> 6622 SAMPSON RD 6622 SAMPSON RD 6622 SAMPSON RD 6622 SAMPSON RD <br /> STOCKTON,CA 95212 STOCKTON,CA 95212 STOCKTON, CA 95212 STOCKTON,CA 95212 <br /> Net 30 Days TPID: 1598521-01 Net 30 Days TPID: 1598521-01 <br /> JIM HAYNES 209/545-5656 JIM HAYNES 209/545-5656 <br /> Trailer: 53663 Type Description Qty <br /> Type Description Qty TIRES Woe Tires 46 <br /> TIRES Whole Tires 17 Total: 46 <br /> Total: 17 <br /> 1 certify that under penalty of perjury under the laws of the State of California that the Infori <br /> Provided above Is true and correct. <br /> I certify d-,at aider penalty of perjury under the laws of the state of California tot the information <br /> provided above is true and correct. Generator Signed: rico <br /> Generator Signed:joe <br /> 0 V 6L <br /> I certify that under penalty of perjury under the laws of the State of California treat the Inforr <br /> provided above Is true and correct, In addition,1 am aware that falsification of this informal <br /> I certify that undo penalty of perjry aider the laws of the State of California that tine information result In suspension,revocation,or denial of renewal of the Waste Tire Hauler Registration p <br /> provided above is true and correct. In addition,I am aware that falsification of this Information may vi Rbllc Resources Code section 42460 and may result In civil penalties ups abed i 0 per t <br /> result in suspension,revocation,or denial of renewal of tine Waste Tire Hauler Registration pursuant violation or ode Section 4 penalties uP to$5,000 per violation per day as described In PubII <br /> to Rblk Resources Code section 42960 and may result In civil penalties up to$25,000 per dal,per <br /> Resources Code Section 42962. <br /> violation or administrative penalties Lip to$5,000 per violation per day as described In Public <br /> Resources code section 42962 Driver Signed: JORGE SOTELO <br /> Driver Signed: JORGE SOTELO <br /> 6 <br /> — Y . <br /> Confidentiality Claim;The Information provided on this form should be cc <br /> s confidential,proprietary,and/or trade secret.in accordance with Title 14, <br /> no„ Confidentiality Claim:The Information provided on this form slrmld be considered ° Section 17041 et.seq,should any member of tine public request disclosure <br /> rti Information,I request that CalRecycle contact me at the address and telepl <br /> confidential,proprietary,and/or trade secret,In accordance with Title 14,CCR, number above, <br /> c section 17041 et.seq,should any member of the public request disclosure of this <br /> Information,I request that CalRecycle contact me at One address and telephone Electronic Reporting to CalRecycle:Lakin Tire West has been authorized b, <br /> rumba above. Call to natirinatp In 1tw Wastes—11 kv l Tim Nt-lf +MT eI�tn-r <br />