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Oti92 "N N'd9ti:Ol SIH '9 'APN awil pania)ad <br /> Inedible Kitchen Grease (IKG) Manifest <br /> Stockton Roto Rooter Grease & Septic Service Low 00& 1 2q <br /> Date: T /�� Time. 4 F/PM Manifest 9 L-O/�2 !f <br /> Business Name: 7 eon <br /> Job Site Address: /) zip Code: fCl <br /> s <br /> Customer Name(print): <br /> TKG Authorized Receiving Facility Name/Address (circle dump site for facility) <br /> City of Lodi-Whiteslough SPCF <br /> 12751 N. Thornton Rd <br /> Lodi, CA 95242 <br /> (209) 333-5749 <br /> Date of CIGG Receipt: ,�/1f� Time of 1lCG Receipt:��r Total IKG Received: <br /> Septic -ease- <br /> Receiving Facility Rep.Name(Print] ���` -i~ (Signature): ,'� <br /> Authorized Transporter: 'V'ehicle Decal Number: <br /> Stockton Moto Rooter Driver Name(print): Eul' LO l QA � <br /> 422$Newton Rd - _....._ .9—•------- �";:�f <br /> Stockton,CA 95205 Driver Signature- <br /> 9 d B91 'ON AVWfl S�H '9 .ASN <br />