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Dec 27 2016 17:0523 CST FROM: P7M/50046309011 MSG# 1736935401-005-1 PAGE 044 OF 062
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<br /> kickup Receipt ntc�p Y1��1: o�il3�zo16
<br /> CA
<br /> EDT X ifant; 11026�6040
<br /> »DT Tad,P Log: 571121
<br /> aCoxm I>re; o�5aa
<br /> TOC.K`TON KOLUIOr DAA Prid JA p,% '+� 1 j tZ
<br /> 3223 E tjAm ysR Lkp;E Lakin Tire 'Host
<br /> STocxro;ti , CA 95212 16305 3prinq Ave
<br /> PHONE: 209-473-343B Santa Pa SPringa, CA 9OC70
<br /> IPID: 1331982..01 PHONE: 800-48a-2752
<br /> TPID: 1000659-0,1
<br /> Truck; 4234a
<br /> Trailer: 536S8
<br /> T,icenae Number: 9F'3482.9
<br /> At9i3t.tatiOn: zb-Oz3�15
<br /> State: GA
<br /> Itoea (S,Thola T�,zmta} Q�'
<br /> :irac Ilickcd Up: 150
<br /> Si-cm^iRttrra`. � NAo�o_ , DRXvT,R2 wpT1EX,4, dORG7E N
<br /> WVr �,,.. .�„ " ( rartlfy I,Irat Unaer peneLLV of nwr,�ury kinder "•IJ• lama. VC CIN 3Gete
<br /> '.{<i '.1'li.Sl:l,\I gal li �'' 01 Cdl�Jln/nJh t1,ot. t.hw Sn fgrAR4iry:7'YVvLJ.? alKgVa L� Cr11� wll� Corr►V l`
<br /> �N )c:t .t+ In nraxl.Ltlon, d en w�wte cl,et hJelf lcecJ o4 ul eh.l. 1r.iuc¢atlnn mqy
<br /> aW ��' .coeult le auepelleir4, rrugceC.l,on, or de,r!<t1 of renrraJ ht r,he veees
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<br /> eMJ moy r.n�lt 1/,e1v L.a 'lJ fe C1OLL- decd Col
<br /> ty.W! ,1"?tx 't' 'dt1�h1 1 ^:. Y161.bvlbh AG D'nnJ[S�A up to U6,0.10 pan 4,1}r, per
<br /> •.rl b�,�1'(, r>-�'•), £,'' f' .,- �^ Odx+1.IL(ambl:,va p+neltlwn U. b4+ L•L.o
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<br /> GENERATOR: PATRICE
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<br /> z'Y'�lif3:^ h,w�d �;. �T1rdNie ��1T5k3a 1 celtlfY tJ1at vltder pule/ty ci ar;ur ar�Je
<br /> Of Sn111 ut ala t110t Lha 1 D Y L nMrr lei v( Lhe 9cet.
<br /> sAt,oca."^
<br /> Dlc•cneClOn yt•vvlU+U ahr?vd .ie ttOw u,d '
<br /> X7114♦ CoaId utiat,ity C aim, 'rho infarmati.on nrovidnd on Chia turns mh.oul.d ba
<br /> �a cary�idarad Gvn�itlerJlial, Ptoprietary, and/or txode, oocret, In aacorcLanao with
<br /> Tittle 14' CCA' SeCtioll 17041 et—l"' 'houl,d any IamJllbez Or the public raquoot
<br /> r ClIsCloayro of th's lnfor=atlon, I Xocr.Jaat that CalAocyalb contact i4e at t,ho
<br /> 6dd.rO03 and telephono number above.
<br /> Ta.®Gtrorata'noporti.nq to calpAwyal.el Lakin Tire Wort hen beer, authorized by d
<br /> cal"cycie to pa;rtiGipato in the WantoZOT °
<br /> roporting proVrrata. on boats' Qt t11a cuocamdoruIlltedaonathidpfd ter, xaxklnQlactri to
<br /> >Weat will el.ectr:onically trannmi,t to CalRoeycle all required 1.fi�ozLikk ll from
<br /> this mAniPeot. colRecy�clh hqa Approved tbb Lakin Tiro Womt EAT flyrltt for utr
<br /> within the WAzle Tire Manifest System EL1T Prov-mn. '
<br /> ilucrsCiat�>a? Vloaor contact your CuCtcjnt!. Saxvico Reprosentative Alt 900-488-2752 or omail
<br /> f;uatamorac�xvica�l akinr,':ir@,cc>,m,
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