ARCHIVED REPORTS_PUMP RPTS 2015 - Laserfiche WebLink

Home Browse Search

SGH 'IN NVS� ll SIH '0 'qad aW Ii paniaaa� 5TF+-i p.Q1=.C:)Ll ORl�,I? !i_ ARaTNMN'f OF FOOD AND AGRICULTURE Mead Poultry and Egg Safety Branch 1220 N street , y Manifest No. I! Sacramento,CA. 9814 &; `^��: (916)900-5004 "_ !. 79-124 (Est.n/12) - r Ma s Ined le Idtc iexib. reti e Transport- t Xnsiar»leflitans and Reeeivi -Faci�.i�ty Information i. —' SA complete JngMble J�tc].en P.,,...rea�e G)Tops ort Manifest.for a 102:dof IKG consists of this form W .and sA generator copies from'MFES Worm 791.25(Ma7uffest-Inedible Kitchen Grease Trauspoi-t, ' -Generator Tifo3inati6n)'fox:gemex'ators'tlW""coAOibu e 1KG to the'Ioad.-Aitematilve the 1 G, transporter may use other fortis that contain all required information. All forms in each manifest must ?have the same Manifest N'ainber. Transporters must Ije4,=c&i*-6teU"-,—* azfests fw;.-fi'o years.. Manifest Instrue4jons_ 1. The driver of the 1KG transport vehicle is responsible for entering all1n6 n iaiion on this farm and on MPES Form 79- L) 125, Manifest-lnedible[rtchen Grease Transport-,-Generator In€orrnanon, exc ep#.for in the Receiving Facilibj :Representative and Generator Representative name and'sigria'ture boxes. All entries must be in ink and legible_ The =driver must initial,any corrections to information a[teady.entered ;j 2. Enter all information in the form below for each load of IKG. Give one copy of the completed form to the receiving it face dy'af'fhe time of IKG receipt or mail or deliver the cmpy to th6 receiving-fboility within 15 work_.days.• ;j 13. Enter the Manifest Number found,at the.1 of this form in the Man ,on the generator form (MPES Form 79- 125)for each generator that contributes to thp,loao.' All generator forms from generators where IE G was collected to y make up the load must have the same Manifest Number as the attached Receiving Facility]nformatyon form- 4. Give the generator copy(from MPES Form 79-125)to the generator at the time of IKG collection or mail'or deliver the 1' 'copy-to the generptor within 45 calendar days. 5.Attach the generator forms (MPES Form 79-125)for all generators that contributed to tine load of lKG to this form. Maintain'this form'and-the attached generator forms for two years from the date on this form. Date of HSG Receipt: time of 1KG Receiptof Used Cooldng til❑ ' 1 / f C PM 1KG: Interoeptorfi-rap Grease ? ReceMng FaaiGty Name: s Reteivirrg FaerTrLyAddre�:""" `F Total IKG Received: Measriring McHibd Used: 'Ccinlainervolume•'pf/Reguhed): Percentage Fill Of Required): . Gallons y:, Pounds I Registered Transporter Name: Vehicle Decal Number a;I s Driver Name(Punted): - ,. - ' Rete" 'g-Facility l?QI le(Printed): ,y Drjver5lgnature: Deceiving Facility Reprp_sentnWeSignature: I � Cf�C ti 'd-9LN Wb'L0 : l l'SIH 0 'qad