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9620 '°N N9Z :Z 9`0 '9 'uar aWIi paniaaa� <br /> Inedible Kitchen Grease (fKG) Manifest <br /> Stockton Roto Rooter Grease & Septic � 1 <br /> � Service <br /> Date_ <br /> Time: 1J VI P Manifest#L-6 <br /> r <br /> Business Name: <br /> Jab Site Address: 14 tcJ 1/ ).'2 Zeo_ Zip Code: <br /> Customer Name (print): L){,tom � 1( ) <br /> �.. c�-U -�,� ��'r���(Si�nature : � � � �V <br /> IKC Authorized Receiving Facility Name/Address (circle dumpy site for facility) <br /> City of Lodi Whitespough SPCF <br /> 12751 N. Thornton Rd <br /> Lodi, CA 95242 <br /> (209)333-6749 <br /> Date of JKG Receijot: _/�'Time of JKG Receipt: Total IKG Received: <br /> e'PtRe—) Grease <br /> Receiving Facility Rep.Name(Print) B iQ bN 6P (Signature).' G�? <br /> Authorized Transporter: Vehicle Decal Number: <br /> Stockton Roto hooter Driver Name(priat):_.. os'-', 7, llk(,ULe-, <br /> 4228 Newton Rd <br /> Stockton,CA 9 205 Driver Signature: <br /> d �01ti '°N WdH : Z 910 '9 upr <br />