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9HO -ON &E :Z 9l0Z '9 'u�r ;WI j pan i a3;� <br /> z <br /> Inedible Kitchen Grease (IKG) Manifest <br /> Stockton Roto Rooter Grease & Septic Seiwice <br /> Date. `� "` °� Time: 0611'1 PM Manifest 4 L- 0 � <br /> Business Name: <br /> Jab Site Address: c i�p C—ode: <br /> Customer Name (print):` — ` ,' (Signature): <br /> IKG Authorized Receiving Facility Name/Address (circle dump site for facility) <br /> City ofLodi-Whiteslough SPCF <br /> 12751 N. Tbomten Rd <br /> Lodi, CA 95242 <br /> (209) 333-6749 <br /> 'date of l G Rcceipt:� -rn-IIAI- Time of IKG Receipt-:'Z 5� Total IKG Received: <br /> Septic Grease <br /> fr SII �' <br /> Receiving I~aciIity Rep.Name <br /> Authorized Transporter: Vehicle Decal Number-\�; <br /> Stockton Roto Rooter Driver Name(print): <br /> 4225 Newton Rd 1' 1 <br /> Stockton,CA 95205 v — <br /> Dri er Siature.: <br /> z � d �o �ti 'ON AdH :: . 9 H '9 u�r <br />