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9«6 "N AM :0I S[H 'l l 'd;S mull P;AI ;D;� <br /> Lwar 4 9 <br /> Inedible Leben Grease (1KG) Manifest <br /> Stockton Roto Rooter Grease & Septic Service <br /> )date: t ( 3—� Time: A111/1�� Manifest#L- <br /> Business Name: c l `e-M Cj n a <br /> Job Site Address: cl 75 5, EZ-1 37,-In 67 tl Zip Code. <br /> f <br /> Customer Name (pxint)�� (Signature <br /> U,CG Authorized Receiving Facility Name/Address (circle dump site for facility) <br /> City of Lodi-Whiteslough SPsCF <br /> 12751. N. Thornton Rd <br /> Lodi, CA 95242 <br /> (209)333-6749 <br /> Date of IKG Receipt:Si—/3/�Timee of IKG Receipt: J lc Total IKG Received. ZC2 <br /> SeptieGr easse / <br /> Receiving Facility Rep.Name(Print) f v k 4 � � 1 f (Signature). - <br /> Authorized Transporter: Vehicle Decal Number: _ <br /> Stockton Roto Rooter Driver Name(print): <br /> 4228 Newton Rd � <br /> Stockton,CA 95205 Driver Signature: <br /> z 'd 066 'ON Wd90 : 0l S�0z '[ [ 'd;S <br />