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M6 "N WdZI Z Sl0Z 'Z '[nr moil paA ] ;O;d <br /> JUL 0 2'2015 <br /> E !VlR0P4!FNTA!. HEAL? <br /> -q <br /> Inedible Kitchen Grease (IKG) Manifest <br /> Stockton Roto Rooter Grease & Septic Service LqW,Of :51r <br /> y <br /> Date: to r Time: r? M Manifest 9 L- 0 l�� <br /> Business Name: <br /> Job Site Address: __ �f l Lbi } C Zip Code: <br /> Customer Name(print): ������ (Signature): <br /> IKG Authorized Receiving Facility Name/Address (circle dump site for facility) <br /> City of Lodi-` hiteslough SPCA' <br /> 12751 N. Thornton Rd <br /> Lodi, CA.95242 <br /> (209)333-6749 . <br /> Date of 1kG Receipt: -x-4r, Time of TKG Receipt:____. . Total IKG Received: <br /> Septic Yease <br /> r t <br /> Receiving Facility Rep.Name(Print) ��1 !�� �� (Signature): <br /> Authorized Transporter: Vehicle Decal Number:—/;?- 4 <br /> Stockton Roto Rooter Driver Name(print): <br /> 4228 Newton Rd --- <br /> Stockton,CA 95205 Driver Signature. <br /> 'd z <<z 'ON WdS� : z S�oz z Jnr <br />