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Dec 27 2916 17:84:52 CST FROM: P'M/58846369011 MSG# 173693548'-965-1 PAGE 842 OF 862
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<br /> Pickup Receipt 8lO mp Date: 05/16/2016
<br /> =T matoir—v 1102 52 064 1
<br /> XDT Trip log: 567274
<br /> Mr* 90: 01554
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<br /> Wkt KhRT�S7TOCKTON a �aic1l t rlvrx.
<br /> 3223 E RAMMER LMe Lakzn Tiro WC*t
<br /> 9T UToN , cA 952,12 15305 5prino AV6
<br /> PROVE: 209-473-3438 Santa Fe Spzinga, CA 90670
<br /> TFI'D: 1331902-01 DHoNEi 69q-.dflfl-27ti2
<br /> TPID: 1000659-01
<br /> T"ck: 423168
<br /> Trailsz: 6907
<br /> Lir_t1J:at* MUnbo-r: 9F34029
<br /> Rr9l5trlationt 16-02346
<br /> OZAtQ1 i Cr1
<br /> TC (whole Tires) 4�
<br /> Tiraa Pic Cd 'LIP: :29
<br /> DRIVER: SOTEZA, JOP.= N
<br /> •;�:�;" : :.Cys ss£<�w*• " = u-ttlty r•hat unq►t psrta-y ut 1N•tl ury unU•t tqQ dove
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<br /> Jaiatn.elan(.r'vr1U•d 400w iv
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<br /> KDfq ConLiddonti�tlity Claim: Talo in:ozmatian Drovidod on this form abeul.d be
<br /> eN p Conaid"00 c9nZidOntial, prpriecary, and/or trado aceret. In oceozdonce with
<br /> e xatlo 14, CCR/ Section 170;1 et.seq, should any membwr of L11C pu1:Ya;t.a xog1,1,e3L
<br /> f{, q diaxcloauro of t,h15 .�ntornlhtion, S fQgUeat tr"iat Ca1Rticycle aontaa� me at tho
<br /> address alnd tclephono !lumber a.bovc}_ !
<br /> X10ctt0=tQ Rapo>tiW to aaJ,Ruc�t.ca,q: Lakin Tire want h,aa .been authoritecl by
<br /> callteoy.lo to pavvici.paCa} i,n the Waato and TJP6d Tire Manit64t PbT ol6cxr6rfiu
<br /> royortin.g program. On bob al.f of tnec customer listed on thil+. form, I'Akin Fire s
<br /> W—t will Aamctx'waically tl'.`nJ'9J kit tO Ca1R60yo1a all required jnfox`ma.tion .from
<br /> thio manife3t. CcllRacyClo hits apprCoved Cho Lakin Tire Wenst EDT Por=% tpr use £
<br /> "tbin thq Wante rire 1"Anl,faast syate:tl EDT program.
<br /> QU4stiyr2g�e P7,eane cantoct your CtJat:.cxner scrvzco ROPxoaanrarive of 800-h Q8-2752 or email �
<br /> Cuatomerscrvaco@lakintixo.com. "
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