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9SN "N AV50 :6 S [0 Z 'S '2nV awil Pania�--� <br /> LP <br /> Inedible Kitchen Grease (IKG) Manifest AUG 0 5 2015 <br /> Stockton Roto Rooter Grease & Septic Service <br /> ENVIRONMENTAL HEALTH <br /> PERMIT/SERVICES <br /> ] A <br /> Date: � � � Time. A 1 PM Manifest#L- <br /> Business Name:� ,..3ti'r'g. cd.-'V4 �� c'—'V-g:' <br /> Job Site Address: ,\ 'j Zip Cade: c 459,96 <br /> Customer Name (print a� C �ZTL-f— <br /> V� � (Signature): Aet4—"&� <br /> IKG Authorized Receiving Facility Name/Address (circle dump site for facility) <br /> City ofLodi-`Vhiteslough SPCF <br /> 12751 N. Thornton Rd <br /> Lodi, CA 95242 <br /> (209) 333-6749 <br /> �7 � <br /> Date of IKG Receipt: lS 0-6 Time of IKG Receipt: � ` KG Received: �1 <br /> Septic Grease <br /> Receiving Facility Rep. Mame(Pring eL � C� (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 /> 8 d 1962 °�N AV80 e 6 S l OZ 'S 2nV <br />