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i <br /> 7' �'` 9SN 'IN AVS0:6 5104 'S '2nV awil pania3a� <br /> Z <br /> Inedible Kitchen. Grease (JKG-) Manifest , <br /> 0jq7 <br /> Stock--ton Roto RooterGrease & Septic Service <br /> Date: Time: �' ANI IPlvi 1%4anifest#L- <br /> Business Name: <br /> Job Site Address: (,d 1 , P. L) (f / Ldc�` c,,- Zip Code-- <br /> Customer <br /> ode:Customer Name(print): S�s c Yom:L- : (Siguatare): <br /> IKG Authorized Receivin-Facility Name/Address (circle dump site for facility) <br /> City of Lodi-Whiteslough SPCF <br /> 12751. N.Thos ritou Rd <br /> Lodi, CA 95242 <br /> (209)333-6749 <br /> Date of lKG Receipt:?,V 9/STime of IKG Receipt: Total 1KG Received:/ <br /> Septic Grease <br /> Receiving Facility Rep.Name(Print) � (Signature): <br /> Authorized Transporter-- 'Vehicle Decal Number: <br /> Stock-ton Roto Rooter Driver Name rent . <br /> 4228 Newton Rd <br /> Stock--ton,CA 95205 .Driver Signature: <br /> RECEIVED <br /> AUG 0 5 2015 <br /> I-2M PERMIT HEALTH <br /> SEC <br /> RV <br /> Zl 1962 '�N AV20 '6 SIaZ S '2nV <br />