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9�}fSZ6 "N AVJ 0 :6 S 1 0 S '�nV moil paniaaa� <br /> 40W <br /> CEIV <br /> Inedible Kitchen Grease (EKG) Manifest <br /> Stockton Roto Rooter Grease & Septic Service AUG 0 5 2015 <br /> ENVIRONMENTAL HEALTH <br /> . PERMIT/SERVICES <br /> Dater— - Time: AM 4 Manifest#L- 0 j (4 <br /> Business Name: G�'��v►.�cci{-.� ���{0,��1 <br /> Job Site Address: 175 j ai t yr ,r,:� ^_Zip Coder <br /> Customer Name (pr' _ ,� (Sigmatux ; . c� <br /> IKG Authorized Rec' ' ing Facility Name/Address (circle du' p site or fac' ty) <br /> City of Lodi-Whiteslough SPCF <br /> 12751 N. Thornton Rd <br /> Lodi, CA 95242 <br /> (209)333-6749 <br /> Date of IKG Receipt: "i� Tjme of IKG Receipt:I `�G� Total IKG Received:, 3 <br /> Septic Grease <br /> Receiving Facility Rep.Name(Printti` Y ci'` � (Signature): <br /> ,A,uthorized Transporter: 'V'ehicle Decal Number: <br /> Stockton Roto Rooter Driver Name(print): v 1 <br /> 4223 Newton Rd <br /> Stockton,CA 95205 Driver Signator <br /> WVCO : 6 S�0z 'S SnV <br />