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SHFON S [H 0l 'q;j ;Wli pania3;� <br /> Inedible Kitchen Grease (IKG) Manifest <br /> Stockton Roto Rooter Grease & Septic Service <br /> Date; f Time: M Manifest#L- <br /> Business Name: <br /> Job Site Address: Zip Code: (� <br /> Customer Name (print): .���, { ' 1 l_ (Signature) 5G <br /> 1KG Authorized Receiving Facility Name/Address (circle dump site for facility) <br /> City of Lodi-Whitesiough SPCF <br /> 12751 N. Thornton Rd <br /> Lodi, CA.95242 <br /> (209)333-6749 <br /> Date of IKG Receipt: �Time of IKG Receipt: Total JKG Received;_,a 6?., <br /> Septic Grease <br /> Receiving Facility Rep. Name(Prixit) G, )��/ � a ) <br /> �, � i/w i 1r1 ($i�,n2ture <br /> Authorized Transporter: Vehicle Decal Number: �. <br /> Stockton Roto Rooter Driver Name(print): <br /> 4225 Newton Rd <br /> Stockton,CA 95205 Driver Signature: --�� <br /> �l 'd 9L� 1 "N AVE : l SIH 'Ol 'qlj <br />