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1206 "N WdZ[ :Z 510 .[ nr awil pania3ad <br /> STAT£OF CA IFORNLk <br /> DEPARTMENT OF FOOD AND AGRICULTURE , 1' <br /> Mead Poultry and Egg Safety Branch <br /> N Sweet Manifest No:: <br /> 1220 <br /> Sacra= to,CA 95814 <br /> (916)900-500 <br /> 79-734 est 11lI2) <br /> mania-est - Ina tchen area§e 'Transport � ()13q <br /> Instructions and ReceivingyT cpty Information <br /> 'A complete Ineffible Kirtcbten•grease MW)Transport Manifest for a load of JKG comsiists of this form <br /> :,and all generator eopies from MPES Form.79•-125 OManifest-Inedible Kitchen Grease Transport, � <br /> Generator Information)for generators that cdntarfffte IKG td the load. - lterna#Fve ,,the ISG <br /> transporter may use other forms that contaia ail.required information. All forms in each manifest mast <br /> 'have the same Manifest Number, Transporters must beep completed-&u ffests for.two years. <br /> Manifest Instructions: ' <br /> t <br /> 1 <br /> 1_The driver of the lKG transport vehicle is responsible for entering all information on this form and on MPES Form 79- <br /> :125, Manifest-Inedible Kitchen Grease Transport,Generator Infbmiation,Qe c pt for in the ReoeWing Facility i <br /> Reprasentative.and Generator Representative name and sighzlure boxes_ All entries must be in ink and legible_ The <br /> driver must initial any c:orrections,to infbrmaiaon already entered; <br /> 2. Enter all information in the form below for each load of IKG. Give one copy of the completed form to the receiving <br /> facilely at the time of IKG receipt or mail or de&erthe copytoifie receiving facifTtywilhin-45 work days. •r <br /> 3. Enter the Manifest Number found at the top sof this form in the Manifest No. box,on the generator form(MPES Form 79- <br /> 125)for each generator that contributes to theload. All geneCat forms.from generators where IKG was collected to <br /> make up the load must have the same Manifest Number as the attached Receiving Facilrty Information form_ <br /> a4. Give the generator copy(from MPES Form 79-125)to the generator atthe time of IKG coilection or mail or deliver the <br /> copyto the gener'atorwithin 45 calendar days. <br /> 5.Attach the generator forms (MPES Form 79-125)for all generators that contributed to the load of IKG to this form- } <br /> Maintain this form and the attached generator forms for two years from the date on this form. l <br /> • f <br /> Data of H<13 Receipt Time of!KG/Receipt Type of ❑ Used Cooking of <br /> uTi�� AM p IICG; �y [nterptorlCrap Grease <br /> Gam. <br /> Receivu,g Faty Name- <br /> Rew—Ming Padlity Agdt: <br /> Total IKG Received: Measuring Method Used: Corr1-ainer Volurne'(lf Required): Percerhage FIR of required). <br /> Ions <br /> 0 � <br /> - ❑ Pounds n-df <br /> Registered Transporter Name= <br /> Vehicle Decal Number. <br /> Driver Name(Printed): <br /> Repaving Faaity Repmwntativ Name(Printed)- <br /> W <br /> i�2 L/ <br /> r ter, <br /> Drive8i naRecamng Fa Tdy Imp nisriive Signature- <br /> � d.=z �cz •�N - Wds � � z ���Oz z � nr �,�' <br />