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9SN '°N AVS0 :6 S 1 0� 'S '2nV auJil paniaaaU <br /> Inedible Kitchen Grease (IKG) Manifest ;Epa <br /> Stockton Roto Rooter Grease & Septic Service AUG 0 5 2015 <br /> ENVIRONMENTAL HEALTH <br /> � l � � PERMIT/SERVICES <br /> 9 AMIVI 3 <br /> Date: � ! Time: anifest n L-OIV- <br /> Business Name: <br /> Job Site Address: / 7 � )n��,� fr� �Ca ' Zip Code: <br /> Customer Name(print): ���7���,c //�.. (Signature),-1—/---/-Z---- -- <br /> IKG Authorized Receiving Facility Name/Address (circle dump site for facility) <br /> City of Lodi-Whiteslough SPCA`' <br /> 12751 N. Thornton ltd <br /> ]Dodi, CA 95242 <br /> (209)333-6749 <br /> Date of[KG Receipt: Time of IKG Receipt:� Total TKG 17eccived: _ <br /> = epic grease <br /> Receiving Facility Rep_Name(Print : �1 - (Signature): <br /> Authorized Transporter: Vehicle Decal Number: <br /> Stockton Roto Rooter Driver Name(print): CriUC'1"g1)0 .I <br /> 4228 Newton ltd <br /> Stocacton,CA 95205 Driver Signature. <br /> 9 'd 19H 'ON AV20 : 6 S[0Z 'S '2nV <br />