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FIECEED 9SZFON NVS0 :6�S [OZ) 'S '2nV-,;wil pani90;� <br /> � , -- L) 0 v :�), <br /> - AUG 0 5 2015 Kc <br /> EWRO14MEKrA-HEALVInedible Kitchen Grease (IKG) Manjifest <br /> PEFRMITISEMJIG&ocktou Roto Rooter Grease & Septic Service Lf C(q <br /> Date: Tzme: ",96 PNI Manffest#L-(0 x'41 <br /> Business Name:_V4 e6a( <br /> Job Site Address: 17/ , C t 1 L-6611 , 64 Zip Code: <br /> Customer Name(print) (signature): <br /> IKG Authorized Receiving Facility Name/Address (circle dump site for facility) <br /> City of Lodi-Whiteslough SPCIF <br /> 12751 N.Thornton Rd <br /> Lodi, CA 95242 <br /> (209)333-6749 <br /> Date of IKG Receipt�,P-�5Time of IKG Receipt: Total IKG Received: <br /> Septic x'casc <br /> Receiving Facility Rep.Name(Print) k (Sa ature);� <br /> V <br /> Authorized Transporter: Vehicle Decal Number-- / � <br /> Stockton Roto Rooter Driver Name(print): <br /> 4228 Newton Rd <br /> Stockton,CA 95205 Driver Sionatnre:��� <br /> 0 'd 1962 'ON M90 :6 S[Uz 'S '2ny <br />