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6ti�VIN SI06 'Z 'adV awi j P;AI ;3;� <br /> Inedible Kitchen Grease (tKG) Manifest <br /> Stockton Roto hooter Grease & Septic Service <br /> Date: <br /> Time: ( /PM Manifest A L-O I <br /> Business Name: I L L l Gt fn <br /> Job Site Address: a2_2�), dr r_va+� l ---- - Zip <br /> Customer Name (print): I eAA Anature): <br /> XKG Authorized Receiving Facility Name/Address (circle dump site for facility) <br /> City of Lodi--Whiteslough SFCF <br /> 1275) N. Thornton Rd <br /> Lodi, CA 95242 <br /> (209)333-6749 <br /> Date of JKG Receipt:3" Tame of TKG Receipt: To-Lai iKG Received- <br /> Septic Grease <br /> Receiving Facility Rep.Name(Print) C U �� w (Signature): <br /> Authorized Transporter: Vehicle Decal Number: <br /> Stockton Roto Rooter Driver Name(print): CL5 , <br /> 4228 Newton Rd <br /> Stockton,CA 95205 Driver Signature:- <br /> 6 'd 8161 'ON Wd«:Z S [oZ Z 'IdV <br />