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6ti�2 "N WdD :: S Z 'Ady aUJI j pania�a� <br /> Inedible Kitchen Grease (IKG) Manifest <br /> Stockton Roto Rooter Grease & Septic Service <br /> Date: 7 Time: � 6AX /Ply Manifest#LCJ,�21 <br /> Business Name: <br /> Job Site Address: () 4&1141 L.rt-- _--,- L-e Zip Code• 95.E <br /> Customer Name (print): 'KLY)A/`l" (Signature): <br /> X'KG Authorized Receiving Facility Nance/Address (circle dump site for facility) <br /> City of Lodi-WhitesIough SYCF <br /> 12751 N. Thornton Rd <br /> Lodi, CA 95242 <br /> (209)333-6749 <br /> Date of IKG Receipt: Time of 1KG Receipt: Total IKG Received: <br /> Septic rease <br /> Receiving Facility Rep.Name(Print) 'j,�A7,-Jz?.)gk (Signature): <br /> Authorized Transporter: Vehicle Decal Number- YL 1-/?-.2L, <br /> Stockton Roto Rooter Driver Name(print): &)!)S' <br /> 4223 Newton Rd <br /> Stockton,CA 95205 Driver Signature: - — <br /> C 'd M2 'ON Wd9t Z S l4Z Z .a dy <br />