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Dec 27 2816 16:56:33 CST FROM: "-4/5H0463H9H11 MSG# 173693548'-9e5-1 PAGE 004 OF 062 <br /> 0" ' <br /> Pickup Receipt <br /> r .. . <br /> 15305 Spring Ave Pickup Santa Fe S;r s, CA 90971T p Date: 2/2/2015 <br /> Naulor nod F�rtd uco Faal>y EDT Manifesm 1101326462 <br /> Truck: 334637 CDT Trip Log 11: 506364 <br /> LJCense Number: State, CA/-gDR7640 <br /> $tale; CA <br /> Oecal: 15-02A86 Stora No,:WA01554 <br /> WAL MART STOCKTON <br /> 3223 E HAMMER LANF. <br /> STOCKTON, CA 95212 <br /> Telephone#;209%473.3436 <br /> TPtD: 1,331902-01 <br /> ITEM ............. _ w_ -- ------� <br /> Trallor: 53293 <br /> Whole Tiros <br /> -- Total: 81 <br /> I owyfy that tinter swAtty of par)"Underthetaws or my state of I Cort(,.that under aUrtaity of perjury udder the aWQ of the Stule of <br /> CeAfomir+that the>nformmirnt provided abovo in true and Corrtfc:. Callfornlaynol the infonrtettlon ppnnwlded above to Vuo end correct In <br /> uu�triuwt.i sm awara rant f,94111ca:lon of this infoitrtallon may rne&tn in <br /> nuapsndon,royrxur loo,or oertiet of mnitwol of the Woats Tim He,ufor <br /> Fiegtatrtsttpn ttumuaai to PuWo Rusourr ou Coda wKbori 429W and cony <br /> roeuil in Cfvi!tMalttan up to 525,GM par day,per viotatlon or <br /> Wintinisunrive pwivil ee up to fi5'peo per v.lvlutkvl por dwyuF deaw'Itwd <br /> to PubUt:kayovranq Code Sectlon 42062, <br /> Generator Signature OrivprSi�j mature <br /> Patrice JORCE SUTELO <br /> . A <br /> CornldeirrNallty C141m:Th.Wormar(on provided on thlt:form alloutd bs considered canfldorv112I,pmorlatary.nrdrarirado <br /> ON!I.� �rTvi cearot,in*ccordanrx with Tttie 14,CCR,ag"an t7¢a 1 of uoc{,rhawa uny rntrnivr"of rhe oublta cogtrow rflrc owra or"inform stn,)Mquoctihot CalRecycde Conine:ata at the a4Oraee end telophortp number abo'-*. <br /> W �faetrohlc,.koporel+►�to CalRoeycle:Laken The Wont hae been awhorLzmd by Carlk4ic cin io participale to the uv�rtfa and <br /> Uwl Tiro Montfort EDT alo^fttmfC reportlnp pDQrWh,On h6hodlof IM ouetnnMr IiOted On wit Lakin TIN Wet!wtFl <br /> elevtrort Ariy imnantIt tb C'0r0vYL!In all riO4iAf0 Ir>Tun,tapon.0440 thfa n%Cnlft74L Ga[AvcG'410 heti OPP,r teed Uro t- Irt Tho <br /> West EDT krm for u"wlthln tho Mate Tire htonlfnat 5ystern E-DT prWram, <br /> pI <br /> r <br />