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Dec 27 2016 17:02:12 CST FROM: F'M/50046309011 MSG# 1736935401 -905-1 PAGE 031 OF 062 <br /> Aff <br /> 1AWWAM 11 1� <br /> suit <br /> Pickup Receipt �kvp Afo t:x1101534997 <br /> =T Tr1V Xog.' 549,594 <br /> 9tozm no: 01554 <br /> = Hnill eg one.End US 145111-22 <br /> NAL MART 3T+JCKTON Lakin Tiro What <br /> 3223 E KM-MR Lt'1N2 15305 Sprig Ave <br /> STOCKTON , CA 95212 $ant& re springs, CA 90670 <br /> 20fl/413-3438 TYI 1000655.01, <br /> TFT.D: 1.3b1M-01 <br /> T zuG)I: 423468 <br /> TrAiler: 39331 <br /> Liconse Numbers 9P34629 <br /> Regi.3trationi 16'-08345 <br /> 9tat"e: CA <br /> Staon Qty <br /> Tiros Picked Up: lso <br /> ).t}�{yJ?{'T �"s4'yla��N <br /> '�1. <br /> e�. L k � <br /> LC <br /> Y.P.. 1' � '���➢f ,� {'� 1�k <br /> 't •J>>'. <br /> ki :S��`.Ad <br /> I <br /> QoacdAooatj,ai.ty Claim., The ini'orena,t.ign providod on this .farm, should. be �,t�Do't* <br /> considered confidential, propziatmxy, and/or evade aec.rnt. In accordance with io P <br /> aaq, should any membor of the public request <br /> Title+ 14, <br /> dizoloxuro of t:hia informotion, I =oquaat that CalRccyclo oor,tact Me at: C174 a <br /> addrean and telephone member al�ovo, ~ y <br /> ,I Croatia 79Jeportljng to cxlTtosya1e1 Lakin Ti.v West nes bman nuthorixed by • <br /> CCA,. zoct:ion 17041 at. <br /> CalReoycle ttO pa,rticiPatto In th® wsete and l)e.od Tjxa Mifeati aDT oleetronlc <br /> reporting' pso9cam. on bohelf of the cuatomar listed on :his form, Lak1.n Tire <br /> West: will electronically txeramit to CalRccyclo all required information from <br /> Chia tnnaifest:. calRecycla has appraved rhO rAkin 'Tiro wont EDT form Lor uaa <br /> within the W*sto Tire manifest 'System EDT program. <br /> puartiona7 Please contact your cuat:omcr Service Representative at 800-488-2752 0: enmil <br /> cLast;Dant r'a A xvi ca[�l+�k int:x re.coat. <br /> f <br /> i <br /> k <br /> f. <br /> f <br />