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96LFIN Wd�S :Z Sl0l '�[ 'Jlo IWIJ PIAI ;)ad .I - STATE OF CALIFORNIA DEPARTMENT QF FOOD AND AGRICULTURE h Meat,poultry and Egg Safety$ra:nch i22ONStreet Manifest No..'� Sacramento,CA 95814 (916)900-5004 r 79-124 (PsL 1]/12) Manifest -- Inedible Kitchen Grease Transport _ Instructions and 12eceiving-Facility Information L — =A complete Inedible Yitche . xe9se G)Transport AIanrfest for a load of ZING consists of,this form ,and all generator copies from bVES'T'orm 79-125 (NIa ngest-Inedible Kitchen Grease Transport, Generator Ynformation)for generators that edutribidte IKG to:the'load. Alternatively,the WQ . • - I transporter may use other forms that contain all required information. A11 forms in each manifest must ! 'have the same M'Ax ifest Number. T =spoiters'must keep comipieted,maA.ffests-fok.two years` II !IManifest Instructions: ' - II 1.The driver of the IKG transport vehicle is responsible for entering all information on this form and on MPES Fomi 79- :125, Manifest-Inedible Kitchen Grease Transport; Generator Information,.except for In the Receiving Facility II Representative and Generator Representative name and signature boxes_ All entries must be in ink and legible. The !I driver must initial any correc:ljonato information already entered: 2 Enter all information in the form below for each load of IKG. Give one copy of the completed form to the receiving facility at the time of IKG receipt or mail or deliver the copy to-the receiving facility within-15 workdays. :3. Enter the Manifest Number found at the top Of this form In the Manifest No. box.on the generator form(MPES Form 79- , 125)for each generator that contributes to the load. All generator.forms from generators where IKG was collected to make up the load must have the same Manifest:Number as the attached Receiving Facility Information form. 4. Give the generator copy(from MIKES Form 79-125)to the generator at the time of IKG collection or mail or deliver the copy to the generator within 45 calendar days- r 5.Attach the generator forms (MPES Form 79`125)for all generators that contributed to the load of IKG to this farm. Maintain this form and the attached generator forms for two years from the date on this form. Date of IKG Receipt Time of IKG Receipt} Used Cooking Oil - � `,�" I I Type� � ! � I a f I/� gt1A M IKG: r��Interceptor/Trap Grease �" �! Receiving FaaTity Name` j Receiving FacirdyAddtz°s Total IKG Received_ � Measuring Metftod Used: Conbiner Volume'(lf Required): Percentage FTI(If Requites: �Ilons DPounds Registered Transporter Name: Vehicle Decal Number. LL Driver Name(Printed): Receiving f=acility Representative Name(PrbAed): Oriver Signature: Receiving Facirdy Represen Signature:' ! ___�ti d_� 'IN JTn�Ad9s : � _SIOZ +�l ' )0