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-CA <br /> I <br /> g443S loll <br /> Pickup Receipt Pialmr Date: 01/12/2016 <br /> EDT va-ifelt: 1101,5449$5 <br /> EDT Trip Z,oq: 851190 <br /> atom No: 036s6 <br /> n 1511 <br /> FTARSTOM TRACY Lakin Tire West <br /> 940 CXXTPLAL Avr 19305 Spring Ave <br /> TRACY , CA 95376 Santa Fe SXlrings, CA 90670 <br /> 2.09/221-11,64 TPIA: 1000559-01 <br /> TPID: 1694654-01 <br /> Truck: 423468 <br /> Trailox: 53505 <br /> License Number: 5F34829 <br /> AQgistration: 16-02345 <br /> StRtP_: CA <br /> zt® Q <br /> Tiles Picked Up: 1167 <br /> �,Qnature�of Hav1Qr /-oe�,�� <br /> I� Fay ^ ,�,•,,'�tlkl+,,!��,�� ;r r;�;:�i�F�:• .-:. <br /> ?ImM-nur,,II ;I(ri�",i <br /> i17 <br /> Ki <br /> COnfidanti,alltY MALLM' The info=a.tibn pr,Wided on thi3 £Orm should be a C DertQ•.t,� <br /> considered ocnfidential, proprietary, and/or trade aecret. In accordance witl,,j <br /> Title 14, CCR, Section 17C41 et.3eq, shotiLd any m2tmber of the public rnvest <br /> discloxuxe of this lnformarion, i r_e! uest that CalRecycle contact me at the mAL <br /> ad&enaa and telephone nunber above. <br /> Electronic PApoxt-inq to CalReaycle: Lakin. Tire west has been authozized by <br /> CalRecyr,.le to participate, in the Was-'Cin r>anc� Used Tire Manifaot MT electronic <br /> reporting paograr,. On behalf of, tho cuntone•a;, listed on this form, Lakin Tire <br /> West wlll electronically tj;anamit to Ca1Recycle all required informati", frons <br /> thio manifest. Ca1RecyolE! he8 appro�> d they Lakin Tiro West EDT form, fox uma <br /> within the Waste Tire MAW i'Rst Syatetn EDT program. <br /> Questions? ,Please contact your Customer SQ:Mice Repre"ntativeA at 800-488-2752 or email <br /> cua'ComerRi^.Fvj.ceQJ,akintx,re,com. <br />