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9EVON Md :Z 9[0 <br /> 9 uar awil paniaaaa� <br /> Inedible Kitchen Grease (IKG) Manifest <br /> Stock-ton Roto Rooter Grease & Septic Senice <br /> Date:I - l- 115- Time: S G° . <br /> Business Name: lrC az <br /> Joh Site Address---12I Zip Code: <br /> Customer Name(print); m rG:"' r` <br /> (Signature): 1 '`� 7 <br /> IIKG Authorized Receiving Facility Name/Address (circle dump site' for facili#y) <br /> City of Lodi-` biteslough.SPCF <br /> 12751 N Thornton ltd <br /> Lodi, CA 95242 <br /> (209)333-5749 <br /> Hate of IKG Receipt:I?-7-15 Time of IKG Receipt: Tota!IKG Received: <br /> Septic Grease <br /> Receivin.g,Facility Rep.Name(Print)-MaLi� Lz�jc- �RL <br /> (Siy nafu re): <br /> G -L <br /> Authorized Transporter: 'Vehicle Decal Number: <br /> Stockton Roto Rooter Driver Name ri.nt -_(] <br /> 4225 Newton Rd (p )- <br /> Stockton,CA 9x2057 <br /> Driver Signature- -- ...---- <br /> Z d �Olti �N WdE :: 9106 '9 "Ir <br />