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96t6 'ON Md S :Z S [H 'til '110 1w! 1 pania0a�} <br /> Inedible Kitchen Grease (IKG) Manifest <br /> Stockton Roto Rooter Grease & Service Septic Se LOO <br /> p <br /> Date: Time: �� P11�I 1Vlanifest#L d 7 <br /> Business Name: IS <br /> Job Site Address:__2—Z j SACa✓6LjVk e n�0 S Zip Code: <br /> Customer Name: (print):-ea,�K0 (Siguat-are):(�Z�, -e2 2,/ <br /> IKG Authorized[Receiving Facility Name/Address (circle dump site for facility) <br /> City of Lodi-Whiteslough SPCF <br /> 12751 N. Thornton Rd <br /> Lodi, CA 95242 <br /> (209)333-6749 <br /> C� f� <br /> Date of[JCC Receipt: Time of JKG Receipt: Total IICG Received: a21 �V <br /> Septic reale <br /> Receiving Facility Rep.Name(Print) � bl— <br /> &� (Signature): c7(� <br /> Authorized Transporter: Vehicle Decal Number: <br /> Stockton Roto Rooter Driver Name(print). <br /> 4223 Newton Rd <br /> Stockton,CA 95205 Driver Signatare: <br /> Wd9S :Z SIN 'Wl' O <br />