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Dec 27 2816 17:83:21 CST FROM: F-158846389811 MSG# 1736935481-905-1 PAGE 836 OF 862
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<br /> P,?.(71C11p Receipt 1?1Cxup Aatn: 02/22K 03u"
<br /> SAx' TA�utf.lfaaastL Y1Q1.,G�939
<br /> 9DT Trip Lo©', 556546
<br /> store No: 01599
<br /> aW Rxier and 1Ynd Uee Fseility
<br /> WAL %MRT STOCKTON Lakin Tire at
<br /> 3223 E RAMM;R LANE 15305 Spring A".
<br /> 9ToCxV0N r CR 95212 Sdntta re Oprzngn, CA 90670
<br /> PHONS: 209/473-3438 PHONE: 800-980-2752
<br /> TPIQ: 1331902-01 TPIDF 10046b9-•01
<br /> Tmck: 42308
<br /> TraiYez: 53365
<br /> Liconoo Number; 9P'3.4029
<br /> Registration: 16•-02345
<br /> stare: GA
<br /> ztens (Wbale V.xtesl QtiY
<br /> whoa P�t:kcd Ups 19=
<br /> RV Tires:
<br /> Wnoala:
<br /> DRIVER: SOTELO, JORGE N
<br /> 9im�,aRf.�,re,w e*H Y1e�r .� Cbe _>ratt4
<br /> — -- . 1 to rtlsyene[ udder malty rt y.rgwy wnceaA ess LaNa of cna 6[et•
<br /> o, cay;Touan tnet the prov.won ab-- in rue end cotiect,
<br /> A—re Ilhaa {w3/j ilGaC jar. of this 1n.orvathcn Lsv
<br /> _Ari rent H. In nue n"ne�pn, Ywv.r.n+Inn, nr Aan Cel of rnnwrnl cd t.h.G-wca
<br /> l•}[u NaUIQC kamLa:rnr.lon Ir,+sPusnt [o NUGII< 71ve,ucC: (0 09 +O.GLPn
<br /> f.. >'�;°'•e ' /' 'S4� SS! +,, 12960 •ed roe ra—le in 4-11 �e5'[tws to V:2',QOU trar •AnY'• pnr
<br /> 3. i' P. x,,,.l qW,\d:.Sr v1r•latl on or •4n ltd ex Ketive penaLtlea •,p to 0.060 f'*t-vloleticn Per;C FY Kr
<br /> 1JF1'Y ` �_ •.ey +r Uae�r Lt•el1 Ln hrLa�: 14rrwttle GMJe bo Atj GA C?0 f•3.
<br /> GENBRAI'.OR: MARK '
<br /> ,�\i d '`t �` rw.•: to ?H°',�Ut t pu>•1.: VC C•a�l•r tinder• thn }rahu+f, tr+� iltatp
<br /> sltl��+ jf3c"�yxir� �, 4 ( L ��r�try peg w•.a., y n r i
<br /> ��; . r( Cb]S:(xnle ct•et r.he jn.orroaClvt Pr.vltl+n atx>va s,, roue an4
<br /> v:k...-:4�:iw��a��•>.,. :3,:;.tw�, ,:..i •
<br /> •:4t:BGG.
<br /> CoaESd�atiality C1.4m., The information provided on Ghia Form should ba-ANA f
<br /> confidential, propriotery, and/or t:r:adv secrftt. Zn accordance with
<br /> Title 14, CCR, Section 77091 et.aeq, should any mombasx of rhe public zequost h
<br /> a d_5clo5uxe of this informAvion, I reque3t Chat CalRccycle copra= mo at the
<br /> adclovs's And telaphone n.tlmher abovrt•
<br /> 7P,lmetsiasaila Rep4�ttiw to CaiReayae: Lakin Tire Wont has been authorized by
<br /> CalRooyole to gart_cipato in >rrie waatc and Oaod Tire M'anifes't EDT electrOtllc
<br /> x0porting pro7ram. on bmhalf of the customer listed on this form, LAk,in Time
<br /> Neat will ejeCtxorsically transmit to calRecycle ,all required Inforythnicn from
<br /> tjji.a plani foot. Ga1,R.ocycle ham approved. the Lakin Tiro Weat: EDT tO.rm ZOz 'LIQ
<br /> i
<br /> w,iuUn t:ho Waste Tiro MAn.ifant System EDT ProgrAm-
<br /> Uuaations4 Please contact your Custowr. 5ervlco Rep.reaentative at 800-489-275; or o wil
<br /> customozsa,tvicaQlaki>ztlse.g41i1.
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