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9SN "N MSO : 6 S10 'S 'sny ;I I i Paniaaa� <br /> L~ O � 4q <br /> T <br /> Inedible �.itc�.ela Grease (IKG) Manifest RECEIVED <br /> Stockton Roto Rooter Grease & Septic Service AUG 0 5 2015 <br /> ENVIRONMENTAL HEALTH <br /> P F;�II�IT/SERVICES <br /> .Date: <br /> '�-,� ����'�, ; ")!'xme: � � � � AM/PM IYZanifest#L- 0 � d <br /> Business Name: ' -.�A C_� �c !c.✓� l � � � <br /> Job Site Address: <br /> L-'._�f" Zig Cade:'c:iT�14 <br /> �� <br /> Customer Nance (print): —�r ,..���, (Signature): <br /> IKG Authorized Receiving Facili Name/Address circle dump site foi 4alcjnty) R <br /> City of Lodi-Whiteslough SPCF <br /> 12751 Ne Thornton Rd <br /> Lodi, CA 95242 <br /> (209) 333-6749 <br /> Date of IKG Receipt,7— ( :7) Tim,of IKG Receipt: Total IKG Received: <br /> Septic Gx-ease <br /> Receiving Facility.Rep. Name(Print) (Signature): <br /> Authorized Transporter: Vehicle Decal Number: ` . <br /> Stockton Roto Rooter Driver Name(print): � _ `�i ��� *`v <br /> 422$Newton Rd ✓ <br /> Stocli,ton,CA 95205 Driver Signature- <br /> 'd <br /> ignat'd 19H 'CN AV20 : 6 S1OZ 'S ,Snd <br />