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Dec 27 Z016 16:57:40 CST FROM: F7M/588463e9011 MSG# 1736935491-905-1 PAGE 818 OF B6Z <br /> Pickup Recalpt <br /> 15305 Spring Ave Pickup AatU: JT2�2D15 <br /> S-in1a VA Sprinr�+�s, CA 90670 P <br /> HAWar and End Use FtiOity EDT Mantfosl#: 1101358469 <br /> Truck: : 637 EDT Trip Log#: 511683 <br /> Liconso Number. Stole:CA/9097646 <br /> Stale; GA, <br /> Decal: 15-02486 Store No.:VVA01554 <br /> WAL MART STOCKTON <br /> 3223 E RAMMER LANE <br /> STOCKTON, CA 95212 <br /> Telephar*#:2091473-3438 <br /> TPID: 1331082-01 <br /> (QTY <br /> res <br /> _. 2. <br /> __......_121 <br /> 1 o0l y that LsnCkr porwlty,of porjury under thn iliwv of 1hu stnln a' t oorlify inpt tmdor ponany of poryury undorze luwa of thrl Swe of <br /> Callfon-du ihat Iho Information pnavldea9 npuva U uuo and onrreut. CallfomJa Ihat the Inft:rt 1kart Woywad ubove 10 true and aurtoct, In <br /> ndOlticn,I sim fl—M that taletfkatiorr of ihito Inlbnmotion may recuts In <br /> aurt7ensk+n,mvocatwn,or uanlal or rorrawoi of the Wasto'f lm I.1qulor <br /> Registration puracwni w Public gasaumpti Cod*asction 42960 and miry <br /> ranult In civil pwifthi"u,tc U5,000 per day,oar vlclatfain or <br /> ourriolmrttUvo 00naws up 14 SA'00 t pAr vioiavon per day a6 dMWt)otf <br /> In PUb*-RgRatffae3 Cndet S:i�t(Pn4,;tx9.2. <br /> GpnemtorblQtt�tur�+ LlrlVerirtllJrd <br /> csmmran JORGE tiOTE,LD <br /> i ✓f , <br /> lr I <br /> )OaW Contldontlallty Clalm.Tho Intctmatlon pmAdodon this rorm should Do cmnStddW cnnfidurttlnl.prv�rletArryy,AndrOr IrmCa <br /> 'A( T McCort.In 00Wrdonce with Title 14,CCR,Sac6orn 17041 at.e+oa,chcutd erry membor oti'ha out�llo reg44af 41aftmuro Olthla <br /> I y I.Mbrrn'00n.t roquoyl um CEticcyot aontaCt rte at the oddMiS and telephone number pbQve. ; <br /> �e MaCtrnwlr R"rUN to C.a;koGyQ10:LoWn lire Wtml ftp*ba6n aGtttceL�gd by CYIitVyr.i8 Ip parriCIDWS In the Womm and i <br /> Urod Tiro MaMteal EDT aloetronlc maDmimo"Va(D.On Dehntlniihe cuetomor Baled on thin form,lokin Tiro Wort will a <br /> ofwnm"liy vunamit to Oalga yaly nil rogalrwd Infomotlan tram thio mnniNw, �Co Roeyde his reppwvod the L■kln Tire i <br /> Wom 407 torrn for ung within IhI wade I tre Manlfw Syttam EDT xnram. <br /> C <br /> C <br /> C <br /> i <br /> r <br />