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Dec Z7 Z016 16:56:44 CST FROM: V7M/50846309811 MSG# 17369354P1-005-1 PAGE 005 OF 06Z <br /> FrICRUp Roaelpt <br /> 15$05 Spring Ave <br /> Santa Fe Span s. CA 9(71570 Pickup Date: 219!2016 <br /> HCuler and nUse Family EO r Manftst o, 110133(1806 <br /> Truck; 334637 EDT Trip Log 0: 507040 <br /> Liwnw Number., S46to:CA 191)97640 <br /> StalU; Cit <br /> Decal: 15-02485 Store No.:WA01554 <br /> WAL MART STOCKTON <br /> 3223 E HAMMER LANE <br /> STOCKTON, CA 9.5212 <br /> Talephcrie*:2091473.3438' <br /> TPID: 1331962.01 <br /> ITEM <br /> valler:,6907 QTY <br /> Whore Tim% — .. ._`,,�--.,..__.__ W_ ,.•. ..r_.,._��_.._._ �'__�— <br /> IF~ 7S <br /> I codify Thal undar perwtiy of perjurf underthe[ower of irw stow of, !aerity that uhdor pnnaay of perjury under tfya rawn of rbo samo of <br /> Co)laurnln 1Imr1 till Infarmottart pnlvidod nbvre la true end cwroct Ca3ifarnls tM1 the InfoamaUtm p[oMdr+d above Js truo dad correct In <br /> 0010011,1 Ctrl aware shot falajicAdon of thitr Ifl0 r7mgtlofl mayy coc/tjt it, <br /> taualsandfon,rov(ocatlon,or ddniel of rcndwol 9f iate,V%Tama_Finn Ha4tsr <br /> RNLr,r&1w puetuatnlz PutAle Resoweac Godo%Vodton 420130 and Cray <br /> 10001 in*Nil nanONleG UP to 626.000 par day,per vx9aliun or <br /> odminlstranve pHnatlies up to 55,000 Per wo4ailon car day an aoxaibed <br /> m F'uok R000urcoa Cddi$dation 42962. <br /> (3onerator Signature Driver SIF mltaro <br /> irBdtlie JOR05 200T'ELO <br /> 1'" '9IDr . � r2•� J/ <br /> f <br /> _ _ I <br /> Kato Confldontiamy rtslm:TNa InkrMucoh prwlded on INS ft>rrrr should 170�nptdarod corri-donllol•propeleta .antl(w tnt4V j <br /> T� aoc'ot,In oocr2n lAnoo with Tltic 14,(:(:A g00An 1 X0.11 6Tce pilw> d any member o►tho pubic ryry <br /> C4 Y royurrcl dleclooure u}!hay <br /> infomuftlon,t roqueet that CelRecyd,conlnot ma Al tib odtsnraa and uotephone nalmDer above. R <br /> Ewctrnnlc ReporUng to CallRacyclr:!akin Thra Waer tors baen nutrjWzad by GriRaoycl�fo;pparlltYpbta In the Walla And 1 <br /> used Tiro Mairnpo EDT CA <br /> -wuv ld roaurogo�ro IfTfor at to f oM iwo wirraflkff lhJR y tnl&harm,Laskin Tiro Won will <br /> alamare+iceRy trnnomk to C4H2oryUe au repo reo Irrformalipr from Ilrbe manrfe6t rrelRecyGe naa approvod the Lakin Ttre <br /> Weai EDT form for use WiNn the yVmale Tlry Mardfoal System EDT program. <br /> I <br /> i <br /> 1 <br /> f <br /> r <br />