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96L6 '°N AdtiS :Z S I 0 til '}a0 awil paniaaa� <br /> Inedible Kitchen Grease (JKG) Manifest • <br /> Stockton Roto Rooter Grease & Septic Service D <br /> Date: /y''/ Time: , <br /> • U AIVI`PM ��anifest#I,-D��� <br /> Business Name., <br /> Job Site Address: �& <br /> e: g� <br /> Customer Name (pri>ut): (Signature): <br /> IKG Authorized Receiving Facility Name/Address (circle dump site for facility) <br /> City of Lodi-Whiteslough SPCJi <br /> 12751 N. Thornton Rd <br /> Lodi, CA 95242 <br /> (209)333-6749 <br /> Date of(ICG Receipt: / Time of IKG Receipt. Total IKG Received: <br /> -6Septic reas <br /> Receiving Facility Rep.Name(Print)BtQA*,� LN�rsP (Signature): s� <br /> Authorized Transporter: Vehicle Decal Number- <br /> Stockton Roto Rooter Driver Name(print): <br /> 4228 Newton Rd <br /> Stockton,CA 95205 Driver Signature: <br /> S d E6ti� 'ON Ad9s : Z SIH '�I 'Po <br />