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Dec 27 2016 16:57:55 CST FROM: F'M/50046399B11 MSG# 1736935401-905-1 PAGE 911 OF 862 <br /> A'Af y° Pickup Retelpt <br /> 15:305 Spring Av5 <br /> Santa F6 Sprin s CA 0067o Pickup Dalto; 411/2016 <br /> Hauler and EnTiUsie Facility EDT Manifest#: 1101364181 <br /> Truck: 334837 EDT Trip Log#; 512635 <br /> License Number; Stats:CA/9DO7640 <br /> Sint* CA <br /> DOC,* IC-024S6 Store No,,WADI 564 <br /> WAL 1V[ART STOCK'TON <br /> 3223 E HAMMER LANE <br /> STOCKTON,CA 95212 <br /> Te10 p f l o r W#: 2091473-1438 <br /> TPID: 1331982-01 <br /> Trai3cr:5:1970 �.,..,_._. __.___...,_.__ Q'rY <br /> WhNa TJms — ,._.. ..._ .. <br /> - �7a <br /> �-- �._. ... ... ._ Total: 76 <br /> I oa0y out under pefu4 of pGnuty undorsno lQm of Ino St�to o' I cartlry trot under paflalty of parlury under th•InwrJ of the,Mose of <br /> Callbmin Iftol the Infrxmntlon pit�vfaeld above In true end cnmeca. CAIKnmlh that the It,fortrle:lon PProvltfad oik"la true and aonect, In <br /> addMlan,lam awaro that f"15=00rt of MIS Information may rosult In <br /> =uogqee <br /> rsalan,rAvoe:ativn,Or 4otdtrl of ranawol of the Ws"Tb*Hoular <br /> 1"llen purreuunt.to Pubk,F7mmrc"Ccdo womion 42w and may <br /> roautl In oivil penarloo up to$2,S.000 par dry,mer vioiailon or <br /> adminlnnttUvr,fpMtal:{a.up In$5,000 Por vidalion per day oa de ocrlbed <br /> In r'uWlc Reaourcee Code SaClorr 4296.1, <br /> C>pnmretgr%qJgnt2tllfF7 13TIVarSJgnatum <br /> Pat JORGE ELO <br /> f�. <br /> t �. .�• <br /> ji <br /> �r <br /> Qa , rOrAdsn IMTY Clalm-Ths krformRMn prQvfdod an 11119 form should do conaid.r.d unnf)dentiof,proprtofnrryy.And/or trades j <br /> a(t mf.In anooroanov with Title 14,COR,Sectlor 17041 etAOQ,rlaeuld any msmbarofth4 publlareptw-ii dlnclonwro of thk. I <br /> Information.I t0qu=1 utat(10 Ree;yd,Conlact me at Ire eddsosa and telephorro numeor above. <br /> c Rfor traedcROOOMPnU to CNIROOWl.s Latetn Tae.Wee ran b~i autlror(Z&d by CaAft-y n to partk tpofu In(no Woa10 and l <br /> Vuei1 ifro fvlar Moat EDT siuclrvnl�roporllng proQrpm.On t>.hnll 01 ihv cusromar listed ortthle fprm,Lakln Tfro West tviR <br /> a1aCSrontGntly tnf�nm121m CalC7ercyclr+Alfty tl krlmrnrJJpn hem this«wnlfo4l CrAIRen.y4fm 114o ppprove>d the t,,aklrl The I <br /> Wa4t ED'T h elgj.fm uw within the Wo"lira lvtanlfoet System EDT program. <br /> W <br /> l <br /> E <br /> t <br /> e1 <br /> f <br /> F. <br /> t <br /> SCe <br /> f <br /> t <br /> Y <br />