ARCHIVED REPORTS_PUMP RPTS 2015 - Laserfiche WebLink

Home Browse Search

M6 "N Md :Z Soz z 'Inr awil PaAl ;);� STAKE OF e.v 1F0P* X - — - DEPAItTNffNT SOF FOOD AND AGRfGUf,TURE Meat,Pou3 and Egg Safe Branch _:��...,.«.�..� ...;W. ..•,.; � 2 120 N Street" tre�at � y�;11JlanifG'�fi� No.:' -003 r J Sacram=to,CA 95814 0 ,ERVIGEQQ (916)900-5004 P, Y 79-124 (Est 11A2) — M=ffest , In.e& e,Kitchen: Grease rfiranisport r In.str4 bis and Recelvmg•Faeolty Informlation 'A complete lneclible Kitche4,�Orease EKG)Transport Manifest for a load of XKG consists ofthU form _,and all generator copies from MI'ES'Fo7rm 79-125 (Manifest-Inedible Kitchen Grease Transport, � Generator luforniation)-for generators that cdntrUnute JKG to the load. Alteruativeiy,the IKG j transporter may use other forms that contain all required informatiion. Alll forms in each.manifest must "have the sae Manifest Number. Transporters•must keep completed•maesfs for-two years. Sam* ° E Manifest Instructions: ' 1.The driver of the IKG transport vehicle is responsible for entering all information on this form and on MPES Form 79- ' :125, Manifest-Inedible Kftchen Grease Transport Generator Information,;e eptfor in the Receiving Faciirt]/ Representative.and Generator Representative name and sigirdture boxes. All entries roust be in ink and legible. The ! driver must initial any corrections.to information already entered; 2.Enter all information in the fool below for each load of IKG. Give one copy of the completed form to the receiving fac7lay at ifie time of IKG receipt or mail or defier the copy tottie receiving facility within-15•work,days- 3. Enter the Manifest Number found at the top bf this form in the Manifest No.boa.on the generator form(MPES Form 79- 125)for each generator that contributes to the load. AlI generator,forms from generators where 1KG was collected to make up the load musk have the same Manifest Number as the attached Recerofng Facility Information form. 4.Give thepY enerator co (from MPES Form 79-125)to the generator at the time of 1KG collection or mail or deliver the 9 f copy to the generator within 45 calendar days_ _ S.Attach the generator forms (MPES Form 79-125)far all generators that contributed to the load of lKG to this form. Maintain this form and the attached generator forms for two years from the date on this form. Dale of IKG Receipt Time of IKG Receipt Type of ❑ Used Caoldng Oil f I �. FM IICG: InteneptarlTrap Grease U ✓✓ i Receiving FaaMty Name: i Rewiving Racility Rddres5:"-- 1 7 � I LI° fvl i Z' total iKG Ret�iived: Measuring Method Used: Carrtainer olume'(If Required): Peroantage Fiff of Required): Gafloas - � Pounds Registered Transporter Name: cJ vehicle DecW Number. - S in C_ 6016- axil e N . e(Printed); Driver Name(Printed): /n fl S Driver Signature: RemM cartjr R presentative Signature:' f Z 'd ZILZ 'ON Wdtil :Z SIOZ z 'Inr }-1