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Dec 27 2016 17:02:39 CST FROM: F-"150046309011 MSG# 1736935401- ' 05-1 PAGE 033 OF 062 <br /> -• •� � •w.�.a aq't l`i r.V ULNJC)CDJ <br /> Aria LjQW Mimi, <br /> 11114 11111111111111 <br /> PiCkUp Receipt paw Data: 01/11/2016 <br /> Viol Mani o4t: 1101544o55 <br /> =T Trip X*V: 551056 <br /> Start No: 01554 <br /> f4 r=A92 r mule C a�ad E �. Veo lYn-y t t,. <br /> WAL MART STOCKTON 1.114n Tire 'We!et <br /> 3223 E KAME,R LW' 15305 Spring AV6 <br /> STQCK1TOT; , CA 9521.2 50nt4 Ye vprin94, CA 90670 <br /> 20,9/473µ3438 TPID: 10006SD-01 <br /> TPID; 1331962-'01 <br /> Trucx: 423466 <br /> TxAiler: 9905 <br /> Licanp►o Numbex: '9F34025 <br /> Registration: 16-02345 <br /> fita.ta! CA <br /> T taxa QWy. <br /> x11=5 pickod Up: 1 5 <br /> W. <br /> 1 <br /> Congid—tial.ity Claim: The ini'orma.t:on provided on this form ihov1d be <br /> conic eyed 0011fidential, propri.eCaxy, alga/or tkade -voeret. In alocordxnae with ' ���� <br /> Title 14, CCR, Soc=ion 17041 er,,.� shoa�l4 <br /> any me or of tho o <br /> �1= Y publ.l.d regaaesc ..4 <br /> disolopuro of thio infornant.ion,. I ccqueLt that Calperr Cle Contact me At the q <br /> aaddrwis sand telepbone numbor. Aho � ¢ <br /> ra.0jrQZ-V0U,C zuPaxtd nu to CAIMer;7ole: Lakin fire W9at has been authotized by <br /> Ca1A00Y010 to partl0ipeato In the tvasto And Usad Tire Manifeat EDToloc:tronlc <br /> ,reporting program. On hohaal.f o4 the Cuarormer litstod an this form, Lakin Tire P, <br /> Kest w112 mleavronlLeclly tranemit to CalRocyol% All required information from � <br /> r,hiv MAnifOut. CAIROCYalc hair aPprovcd tho Lakin fixe wa me EDT form for use <br /> ws thln the wjizve Tire: Man.Loat system JT program. t. <br /> Quceti,ons? ly1ea5e confect your Cust=er sarviee Representative at 8.U0-488-2752 0: ornail <br /> i <br /> cua,~om�zaervice(�1'akintixc.com. �: <br /> f <br />