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1806 'ON M [ :1 SIOZ 'Z 'lnr aWl j paniaa;� <br /> Inedible Kitchen Grease (IKG) Manifest <br /> Stockton Roto tooter Grease & Septic Service <br /> Date: 4/, -, ~ f� Time: d_ PM Manifest 4 L-b <br /> Business Name: <br /> Job Site Address: Zip Codec <br /> Customer Name (print):Mcu FG r <br /> .r � °, (Signature <br /> IKG ,A,utbiorized Receiving)Facility Name/Address (circle damp site for facility) <br /> City of Lodi-NNIffeslough S-PCF <br /> 12751. N. Thornton Rd <br /> Lodi, CA 95242 <br /> (209)333-6749 <br /> Date of ICG Receipt: '01'/5' Time of IKG Receipt: 1 Total IKG Received: :� z <br /> Septic cease <br /> Receiving Facility Rep.Name(Print) L^5 C Pft (Signature): <br /> Authorized Transporter: Vehicle Decal Number: <br /> y j <br /> Stoclton Roto Rooter Driver Name(print): <br /> 4228 Newton Rd / <br /> Stockton,CA 95205 Driver Signature: <br /> L 'd Z1LZ '°N WdSI :Z S1OZ Z 'lnr <br />