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CA LAKIN 111111111111111111111 <br /> 1101460102 <br /> Pickup Receipt Pickup Date: 09/05/2015 <br /> EDT Manifest: 1101460102 <br /> EDT Trip Log: 532699 <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: 334637 <br /> Trailer: 2011 <br /> License Number: 9D97640 <br /> Registration: 15-02486 <br /> State: CA <br /> Item jQty <br /> Tires Picked Up: 144 <br /> Signatures of Hauler / Generator, <br /> i <br /> Confidentiality Claim: The information provided on this form should beQt <br /> considered confidential, proprietary, and/or trade secret. In accordance with C'%% a r <br /> Title 14, CCR, Section 17041 et.seq, should any member of the public request %, p <br /> disclosure of this information, I request that CalRecycle contact me at the y `• <br /> address and telephone number above. '(b <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 />