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9620 '°N Md :Z '9lH 9 'upr✓aWil pania�a� <br /> Inedible Kitchen Grease (IKG) Manifest � <br /> Stockton Rota Rooter Grease & Septic Sex-vice <br /> Date: �. � "� ` Time: `fir ',� i ANI/Pm manifest#L- <br /> ��' � <br /> Business Name: , ; a� <br /> ��- \5 `�r <br /> Job Site Address: 'n.���.� ��.., '��:�:��-� "�- C� Zip Code: - <br /> �-�-- <br /> 4 <br /> 1 <br /> Customer Name (print): R> <br /> G y i'.(signature): <br /> TKG Authorized Receiving Facility Name/Address (circle dump site for facility) <br /> City of Lodi-Whiteslough SPCF <br /> 12751 N. Thomton Rd <br /> Lodi, CA 95242 <br /> (209)333-6749 <br /> Date of IKG Receipt_�, -`"9"�Time of IKG Receipt: 7Total IK.G Received: <br /> Septic Grease <br /> Receiving;Facility Rep.Name(Print) <br /> Authorized Transporter: Vehicle Decal Number:_ <br /> Stockton Rota Rooter Driver Name(print): Dx-�I,-rl <br /> 4228 Newton Rd <br /> Stockton,CA 95205 Driver Signature:' - - ` -- <br /> 9 'd AdH :Z 9 [06 '9 "Ir <br />