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sTATE oFc,�.�olu � titi68 '°N W�cS ? _SIOZ_ 'Ol 'unr�au!il paniaja'I� <br /> DFFARTWiRNT OF FOOD AND AGRICULTURE <br /> Neat,Pointy and E,----Saf ,Branch ' <br /> ... Manifest No': <br /> 3220 N Street <br /> Sacramento,CA 95814 <br /> (916)900-5004Ci py�', ; <br /> 79-124 (Est.11112) <br /> Mangest - inedible Kitchen Grease Transport <br /> Receiving Tac4i In-forma#avn <br /> Iztstl�u�-dps and Re ,g �'' _ i <br /> :A complete Inedible Kitchen� rea'se G�'Transport Ma3�.ifest for a load of IKG consists of this form j <br /> and all generator copies from MFES•�I+'orm 79-125 (Manifest-Inedible Kitchen Grease transport, <br /> Generator Information)-for generators that iydntrl`b"te IKG tri the load. ,Aiternatiivelp,the IKG . <br /> transporter may use other forms that contain all required Wormation. All forms in each manifest must a <br /> 'have the same Manifest Number. Transporters must keep campieted ma>Eufests far two years. <br /> Manii€est Instructions: <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 Information,$xcept for in the.Receiving Facilrty <br /> RepTesentabve and Generator Representative name and signature boxes. Atl entries must be in ink and legible. The !. <br /> driver must initial any corrections.to information 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 /> i <br /> facility at the time of IKG receipt or mail or deliver the copy to the receiving facility within•15 work,clays. f <br /> :3. Enter the Manifest Number found at the top�f this form in�the Manifest No. b&,on the generator form(MPES Form 79- 'r <br /> 925 <br /> for each generator that contributes to the load_ All generator forms from generators where IKG was collected to <br /> make up the load must have the same Manifest Number as the attached Receiving Facility Information form. �. <br /> 4. Give the generator copy(from MPES Form 79-125)to the generator at the time of 1KG collection or mail or deliver the <br /> c <br /> copy to the generator within 45 calendar days_ <br /> 5.Attach the generator forms (MPES Form 79-125)for all generators that cont jbuted 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. <br /> Used'Coolidng Qil <br /> Fm <br /> of HCG ReoBipi -Irne of iKG ReoBipV- Type QANI / Interceptor/Trap Grease <br /> eiving Facirdy Name: <br /> ReceMng Facility Address'`_" " <br /> r , tol <br /> t <br /> Measurir< Used: Container Vol Of Required): Percentage Fill Of <br /> Required): <br /> Total 1KG Receivers: �--���., 9 <br /> ons <br /> Pounds f <br /> f <br /> Registered l'ransparter.Names Vehicle Qecal Number_ <br /> Si plas� dt,,- <br /> Driver <br /> Name'(Printed)_ <br /> 7K�Omng Facility Representative Name(Prints: )= ! <br /> Driver Signature R iv riiity Rspr'esentadve Signature:' j! <br /> ti d LLtiZ '°N Wd9� :z � loz of 'u�r <br />