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LAKW ThR Pickup Receipt 5/28/13 1:07:08 PN Pickup Receipt 3/5/13 12:14:15 Lakin Tire-Stockton EDT Manifest* 1972763 EDT Manifest*2029098 15305 Spring Ave EDT Trip Log *424501 Lakin Tire Stockton EDT Trip Log *433823 Santa Fe Springs,CA 90670 Store: FW00212 15305 Spring Ave 562-602-2752 Santa Fe Springs, CA 90670 Store: FWg0212 Driver: JORGE SOTELO 562.802-2752 Driver; JORGE 50TELO Hauler and End Use Facility Route; ROUTE48 Hauler and End Use Facility Route: ROUTE48 Truck: 334637/State; CA/9D97640 Truck: 334637/State: CA/9D97640 Decal: 13-03886 Decal: 13-038% Bill To: Ship To: Ship To: FOUR WHEEL PARTS STOCKTON FOUR WHEEL PARTS STOCKTON Bill To; 6622 SAMPSON RD 6622 SAMPSON RD FOUR WHEEL PARTS STOCKTON FOUR WHEEL PARTS STOCKTON STOCKTON,CA 95212 6622 SAMPSON RD 6622 SAMPSON RD STOCKTON,CA 95212 STOCKTON,CA 95212 STOCKTON,CA 95212 Net 30 Days TPID: 1598521-01 Net 30 Days TPID: 1596521-01 JIM HAYNES 209/545-5656 JIM HAYNES 209/545-5656 Trailer: 53366 Trailer:2699L Type Description Qty Tye Description Qty TIRES Whole Tires 14 TIRES o e Tires 19 Total; 14 Total: 19 I certfy that under penalty of perjury under the laws of the State of Califa nia trat the infcrmation provided above Is true andocorectry order the laws of the State of California that the Information provided above Is true and correct. y that under p"ty Generator Signed: Brian Phelps Generator Signed:HtO 1 I certify that urder penalty of PerJury aider the laws of the State of California that the Information I certify twit under Penalty a Per>ry under the laws of the State of California that the Information Provided above Is true and correct, in addition,I am aware that falsification of this Information may or deN provided at-we al of �on�re action or denial of reneam wal of the Waseeare that aTlre�Hauler Reon pursuant gtion of i istrfaw Pu� to Public Resources suspension,result in de revoormation maycation, 42950 and maat of y result In civil Pemltles up to$2aste Tire Hauler 25,000tlper day,per resut in to Public or admin Code section 42960 and may result In civil penalties up b$25,000 Per day,Per violation or administrative penalties up to$5,000 per violation per day as described in public violation dx administrative penaltle5 up to 55,E Per violation Per day as described In public Resources Code Section 42962. Resources Code Section 42962. Driver Signed; JORGE SOTELO Driver Signed: JORGE SOTELO 7'." ""'tv aim:The information provided on this form should be considered Confidentiality Claim:The information provided on"s form should be considered confidential,Proprietary,and/or trade secret.In accordance wlth Title 14,CCR, Section 17041 et seq,should any member of the public request disclosure of this confidential,proprietary,and/or trade secret.In accordance with Title 14,CCR, information,I request that CalRecycle cortact me at the address and telepi) e Section 17041 et.seq,should any member of the public request disclosure o this information,I regrest that CalRecycle contact me at the address and telephone number above. number above. Electronic Reporting to CalRecycle:Lakin Tire West has been authorized by Electronic Reporting 0 CalRecycle:Lakin Tire West has been art erized by CalRecycle to participate In the Waste and Used Tlre Manifest EDT electrons Ca,Recycle to participate in the Waste and Load Tire Manifest PDT electronic reporting program.On behalf of the customer listed an this form,Lakin Tire West reporting program.Cn behalf of the osromer listed on this form,Lakin Tire West will electronically transmit to CalRecycle all required Infcrmatlon from this rewired Information from this manifest. CalRecycle,has approved the Lakin Tire West EDT form for use within will electronically transmit to CalRecycle all req l manifest. CalRecycle has approved the Lakin Tire West®T form for use within the Waste Tire Manifest System®T program. the Waste Tire Manifest System EDT program.