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Wd9Z :6 910 '9 'U�r moil Pani ;°;� <br /> Inedible Kitchen Grease (IKG) Manifest <br /> Stockton Roto Rooter Grease & Septic Service <br /> Date: `2--- 1 K` f.� Time: � ��� AM /PM Manifest# YJ I7/ <br /> Business Name: <br /> Job Site Address:, Gc.J- G'T 1 l c�'d V\�,e4Zip Code: <br /> Customer Name (print): <br /> 1KC Authorized Receiving Facility Name/Address (circle dump site for facility) <br /> City of Lodi-Whiteslough SPCl� <br /> 12751 N. Thornton Rd <br /> Lodi, CA 95242 <br /> (209) 333-6749 <br /> Date of lKG Receipt: /2-1 V—iFTime of JKG Receipt:3 W PATotal 11CG Received. % lje-% <br /> Septic Grease <br /> Receiving facility Rep.Name(Print (Signature): <br /> Authorized Transporter: Vehicle Decal Number: <br /> Stockton Roto Rooter Driver Name(print): fiJV J hP L�_ Q_V-\, <br /> 4228 Newton Rd <br /> Stockton,CA 95205 Driver Signature: <br /> U <br /> 01 'd �01� '°N Wdo� :z 91H '9 'upr <br />