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LAKIN TIRE <br /> CA 11111111111111111111 <br /> 1101479721 <br /> Pickup Receipt Pickup Date: 10/07/2015 <br /> EDT Manifest: 1101479721 <br /> EDT Trip Log: 537085 <br /> Store No: 00711 <br /> Generator Hauler and End Use Facility <br /> PEP BOYS STOCKTON LAKIN TIRE WEST, INC. <br /> 4987 WEST LANE 15305 Spring Ave <br /> STOCKTON , CA 95210 Santa Fe Springs, CA 90670 <br /> 209-952-1222 TPID: 1000659-01 <br /> TPID: 1244303-01 <br /> Truck: 423468 <br /> Trailer: 5304 <br /> License Number: 9F34829 <br /> Registration: 15-06936 <br /> State: CA <br /> Item jQty <br /> Tires Picked Up: 1110 <br /> Signatures of Hauler / Generator <br /> Confidentiality Claim: The information provided on this form should beDat <br /> cra- <br /> considered confidential, proprietary, and/or trade secret. In accordance with �G a ''' <br /> Title 14, CCR, Section 17041 et.seq, should any member of the public request 1p <br /> disclosure of this information, I request that CalRecycle contact me at the y <br /> address and telephone number above. <br /> Electronic Reporting to CalRecycle: Lakin Tire West has been authorized by • <br /> CalRecycle to participate in the Waste and Used Tire Manifest EDT electronic <br /> reporting program. On behalf of the customer listed on this form, Lakin Tire <br /> West will electronically transmit to CalRecycle all required information from <br /> this manifest. CalRecycle has approved the Lakin Tire West EDT form for use <br /> within the Waste Tire Manifest System EDT program. <br /> Questions? Please contact your Customer Service Representative at 800-488-2752 or email <br /> customerservice@lakintire.com. <br />