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Pickup Receipt <br /> ISW5 Spring Ave <br /> Santa Fe Springs, CA 90670 Pickup Date: 811112o 15 <br /> Hauler and Enol Use Facilfty EDT Manifest#: 1101443776 <br /> Truck, 423468 EDT Trip Log#: 529023 <br /> License Number; State: CA/9F34e;29 <br /> State, CA <br /> Decal; 13-06936 Store No.: F1O$W6 <br /> FIRESTONE TRACY <br /> 91W CENTRAL AVE <br /> TRACY,CA 95376 <br /> TeWham## 2091221-7164 <br /> TPID: la24854-01 <br /> M <br /> Trailer: 53234 <br /> Whole Tires - <br /> - 171 <br /> `Dotal:; 171 <br /> Califon tlia rinPelatiit o�ariury;dgdoer$Soffa�rue and ft <br /> aarroctof I ce�tiiy dot wbEf penetfy of`a:rjwy undo.the laws d a-,CUtc a[ <br /> GalCiOmia dw t)to V&MM=M Pim"dad alcove is bVe and CU ..L h <br /> ar+ 6MLiarmasars.ttcacfanftue cnoftis wonn3torres.L= <br /> rens on,BroGS00t1,a dtlrd dL of iE»errdd aF07E Ib' '�Twu;-;AQtu <br /> ReglsvacM pcusubnt m Pucllcli c�a Cade**Ghon 429M w¢d May <br /> resun"n civ up so;540M Per my.t�vioje&n or <br /> dnvY <br /> in P rua2l P—itf�up w S€1,t100 per viotat�prt 0e aY as Odd <br /> our=2 cow Se'=Sj n 4296P- <br /> Generator Signature Drivar Signature <br /> jer$my JOIRGE SOTELO <br /> /f <br /> l <br /> Da1�r Coandontiallty Claim:The information prWided on Ihly Form should be aar�de ad q;(Idantdbi proprietary,and/or trade <br /> o Ceecrtrt.In aecOrdance with Title 14.CCR,Seetion 1 Y04'1 W.Uwq,�ahould any rnenjWr itd the p„bllc-qr,�Zt d*dQaure of MM <br /> informstton.I request that CalRwrycle cnnwc�tna At the a6dres,mind tolephane nu order 5bore. <br /> 1v -' Elechonk RepOrtln g to CalRecycle:Lakin Tire Wort hwi boon authorized CalfCL : <br /> WSed TUM Wnif FST etoctrontc r. SS✓ -44JIM to Pani�e In the Waste mid <br /> 0Lkk* )k2tly transmit to CalR q Pte •On he fro of iht: anw-nL tialft0 an 1hQs laiin TIM;rpt <br /> Wiest EDT form for use within the Wastorerue�AAar lest Sin from ttus09rdm Cal►�Dul i die L aim Tape <br /> mem EOT paz�ram <br />