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9SS6 '°Nr-A00 :0 [ � IOZ,, 'll 'das awil pania3a� <br /> V- 1 <br /> Ined ble Kitchen Grease (IKG) Manifest <br /> Stockton Roto Rooter Grease & Septic Service <br /> ]date: Time:—Z12--S--A�rM Mani_fest#]L- v 15& <br /> Business Name: <br /> Job Site Address: (E06 L-44,cv4l ek, C4- zip Code: <br /> Customer Name (print): _ A& ._(Signature): �ml <br /> TKG.Authorized Receiving Facility Name/Address (circle dump site for facility) <br /> City of Lodi-Whiteslough S-PCF <br /> 127751(7 N.Thornton Rd <br /> Lodi, CLQ.95242 <br /> (209)333-6749 <br /> Date of IKG Receipt:(F J6 <br /> p . Time of tiGG Receipt- 'Total YICG Received: J1 <br /> Sep ' Grease <br /> Receiving Facility Rep.Name(Print) r (Sibnatur <br /> Authorized Transporter: Vehicle Decal Number:—/��°G � <br /> Stockton Roto Rooter DriverName(priut): <br /> 4228 Newton Rd <br /> Stockton,CA 95205 Driver Signature- <br /> ti 'd OUE '°N WH90 : 01 SI06 l l 'daS <br />