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STATE ofCAtlFoRMA � 96Z0 '0N,Wd9Z Z 9l0Z 9 -uPr a�uil paniaaa�,� DEPART2lMNT OF FOOD AIS D AGRICULTURE Meat,Poultry and)F,-,-Safety Branch } 1224 N street Manifest No::M-6� Sacramento,CA 96314 (916)900-5004 794I24 (I m 11/12) r Ma-n fest - Inedible- Mtehen Grease Transport . . � �Instr>I�+cfxrs and Iteceivg ac�il�ity Inorxl�a#ao�a -A complete luedible Kitchen xesse 93 l )Transport Manifest for a load of WG consists of this form :.axed aIl generator copies from 1+vPES^Form 79,1.2 (Manilfest-•Inedible Kitchen Grease Trauspolrt, . Generator Information)for generators thatEdixtribute WG to;the•load. Alternative,the lK.G i txanvorter may use other fornwts that contain all required information. An forms to each manifest most � "have the same Manifest Dumber. Transporters'must keep CoOmpleted'mlmriifests fox-two years. f Manifest Instructions: � '+ 1_The driver of the lKG transport vehicle is responsible for entering all information on this form and on MPES Form 78- :125, Manifest-Inedible Kitchen Grease TranspoM Generator Infnrrn on,zxcept 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 correcona#p informaotl alreadyentered; 2. Enter all information in the form below for each load of IKG. Give one Copy of the completed form to the receiving fb6 rW at the time of IKG reciaipt or mail or deliver the copy to-the receiving facility within-15-workdays_ 3. Enter the Manifest Number found at the top Af this form in the Manifest No.box°on the generator form(MPES Form 79- '125)for each generator,that contributes to thp.load_ X111 generator forms front generators where•IKG was collected to make up the load must have the erne Manifest Number as the attached Receiving Facility Information form_ 4, Give the generator copy(from MPES Form 79-125)to the generator at the time of EKG collection or mail or deliver the C copy to the generator within 45 calendar days_ - f 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 dengrator forms for two years from the date on this form" A f Date Of 1KG Receipt rime of IKG Receipt Used Coo&g Oil.---- t Type of L] _ AM n1KG' r Trite roeptorfTrap Grease R6&iving Facility Name- Receivirig ; Total IKG Received-Ir Measuring Metfiod Used: Container VoluMe-(If Required}: Percentage RH(If Required): Gallons i -- , Pounds Regisxerad TransparterName `rte/ 1 1 Vehida DeGat Number- . .\ : O Dmr nn2r Receiving FacUity Representative Name(Printer!)_ { D nvwn--: ; Receiving Faafity Representative SignaMre_' �( r, S 'd Hl 'ON WdH :: 9lH '9 u�r