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Aug. 5. 2015 9: 24AM No- 2964 P. 2 <br /> Inedible Kitchen Grease ( G) Manifest <br /> �11�G 2015 Stockton Roto Rooter Grease Septic Service <br /> �MONMENTAL HEALTH <br /> MIT/SERVICES <br /> Date: — <br /> Time:_ D Manifest#L- <br /> 1 <br /> Business Name: c� y <br /> Job Site Address: � ' , ' ` Ir Zip Code: 5? �i <br /> Customer Name(prxnt):� '(Siguature . <br /> IKG Authorized Receiving Faeilx Name/Address (circle dumpsite for facili <br /> > ) <br /> City of Lodi-Whiteslough SPCF <br /> 12751 N. Thornton Rd <br /> Lodi, CA,95242 <br /> (209)333-6749 <br /> Date of II{G Receipt:- * Time of IICG Receipt_ � ' Total IXG Received_ c z . <br /> e Grease <br /> n <br /> Reeeivina Facility.Rep.NarnePrint K <br /> •� (Signature): <br /> Authorized Transporter:P Vehicle Decal Number: <br /> Stock-ton.Roto Rooter Driver Name(print): `2. <br /> 4228 Newton lid <br /> Stockton,CA 45205 Driver Signature: <br /> i. <br /> Rec e ved Time Aug, 5, - 2015 9: 22AM No, 9260 <br />