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6titi8 'ON WdD :: S10� Z -AV awil p9nia3;� STAT QF CAVIFOWA DEPARV`I NT OA AICD AGPdCULTURE Meat;Poultry and Egg Safety Branch 1220N Street Man"Ifest No:: Sacramento,CA 959144 T (91(5)900-5004 _ l 79-124 (1:5t.11!12) 1VlaniFes . Inedible idea Grew" Fran's aa� J F Instructions and Recgvii ty Information l.r 'A complete Ined>< T..".:: :• :-I- p `ble Kitchen x"M!ONG„)TtaDsport Manifest.#ox a loan ofIXG consists. of this form sand all generator copies froom MFESTO rm 79-125(Manifest-Inedible Kitchen Grease Trartspoi-t, 'Generator Ynf&7 iation),rtor geriera#ors'thaf'Edhtillii a�G#a the Road.°Alternatively;the II G transporter Way use other forms that contain all required informatiion_ AD forms in each manifest must ha ve the same manifest Nnmlier. x-atusportei s must deep=,complete =manifests f6_tivo years. Manifest Instructions: 1.The driver of the IKG transport vehicle is responsible for entering all information on this farm and on MPES Form 7.9- 1,25, Manifest-Inedible IGtchen Grease Trenspo.rt,,:Generator.[nfbrm.ation, exclept,for in the Receiving Facility ,Representative and Generator Representative name and signature boxes. All entries must be in ink and legible_ The 'driver must initial.any corrections to info i . rmatian already.eni~�red; ,2. Enter all irtformation in the form below for each load of IKG. Give one copy of the completed form to the receiving €aciffty'at the tittle df IKG receipt or mail or'del ver the'copy to the receivingfacility within 15 work,.da s_- ' 3. Enter the Manifest Number found at the.top of this form in fine Nfanft_st No. box:on the generatorform(MPES Form 79- i 125)for each generator that cordabutes 0the-,load. All generatorforms from,ge.nerators where!KG was collected to make up the load must have the same Manifest Number as the attached Receiving f=acility Information form_ { 4. Give the generator copy(from MPES Form 79-125)to the generator at the time of IKG collection or mail or deliver the 1 copy-to the generatorwithin 45 calendar days. 5_Attach the generator forms (MPES Form 79-125)for all generators that contributed to the load of IKG to this form- Maintain this form'and-the attached generator forms for two years from the date on this,form. Data of KG Recti ti Time of iKC ceipt Used Cooking Oil ti Typie cf El i IKG: / Interceptor/Trap Grease f Reeennng Facility Name:" r Receiving FacTity-Address':^""� 75_ ? Itia � Total IKG Received: Measuring Method Cued. CdritairerV lume'(rfRequired)'. Percentage Fl!(If Required): Gallonsr it Pounds Registered Transporter Name: Vehicle Decal Number ' Driver Name(Printed): Receiving Facility Representative Nam s(P' ted): f Driver Si nature: g dy presentative Signature: g Receivin Fadr 9 d=861 '�N Wd9ti Z —SIOZ Z add '