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9H6 "N MSO :6 S 1 0 'S any auuil -plan I ;0 <br /> "� <br /> ;L <br /> Inedible .Kitchen Grease (IKG) Manifest <br /> Stockton Roto Rooter Grease & Septic Service RECEIVE® <br /> k <br /> A f AUG 0 5 2C;5 <br /> Date:�7 Time: `� � I �PM Manifest#L- <br /> ENVIRONMENTgL H;EgLTI1 <br /> PERMIT/SERVICES <br /> Business Name: f x-164 Z26 -S\ moi \ <br /> Job Site Address: 4 .(-M,5 - Zip Code- <br /> °° � <br /> Customer Name (print) (Szcynatur <br /> 1KG Authorized Receiving Facility Name/Address (circle dump site for facility) <br /> City of Lodi-`PVhitesloagla SPCF <br /> 12751 N. T'homton Rd <br /> Lodi, C.A,95242 <br /> (209) 333--6749 <br /> Date of IKG Receipt: �r -�-�5Tirne of lKG Receipt: Total JKG Received: <br /> Septi ('Grease <br /> Receiving Facility Rep.Name(Print) "" f�t'.Y (Signature): ` <br /> Authorized Transporter: Vehicle Decal Number: _ `i -7 ";. <br /> Stockton foto Rooter Driver Name(print): ' 5!-a a,-, •1<�� <br /> 4228 Newton Rd <br /> Stockton,CA 95205 Driver Signature.- <br /> 'd <br /> ignature:'d 1962 "N AVLO :6 S 10� 'S 'Snd <br />