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5848 '°N Wd58 ll S[E '0l 'qad ;WI j Pani ;3;� <br /> Inedible Kitchen. Grease (IKG) Manifest <br /> Stockton Roto Rooter{ Grease & Septic Service <br /> A�- �C; <br /> Date: 7- Time: DIVIPM Manifest 9 L-<3 3 1 <br /> Business Name: j ( r=7G ')a '4�5,.j jz� / <br /> .lob Site Address: �it'".Wf Ali-C- Zip Code:�6�2�,�) , <br /> Customer Name (print ignature)/ J <br /> IKG Authorized Receiving Facility Name/Address (circle dump site for fa Ility) <br /> City of Lodi-Whiteslougb SPCP <br /> 12751 N. Thornton Rd <br /> Lodi, C.A.95242 <br /> (209) 333-6749 <br /> Date of IKG Receipt:_.! " Time of IKG Receipt: Total IKG Received: <br /> Septicreale <br /> � e'r <br /> Receiving Facility Rep. Name(Print) ta "ianftture): <br /> Authorized Transporter: 'Vehicle Decal Number: :7 ,!2 <br /> Stockton .roto Rooter Driver Name(print):_....�` �/ <br /> 4223 Newton Rd 1 <br /> Stockton,CA 95205 Driver Signature: <br /> l l 'd 9081 '°N Wd88 11 SIOZ 0l 'qad <br />