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9616 'ON a��i N NdtiS : Z �I0 bl '� 0 IPS / <br /> o a ;A I ; <br /> Ynedible Kitchen Grease (IKG) Manifest �•o QKq <br /> Ston _'- Rooter Grease & Septic Service <br /> Date: 9-1t4,1,1 Time: �. AIVI Pi•I Manifest#L- 01V <br /> Business Name: <br /> Job Site Address: Zip Code: Y 2��, <br /> Customer Name (print); _ �cf�, �y� � - (Signature): <br /> TTG Autbiorizedf Receiving Facility Name/Address (circle dump site for facility) <br /> City of Lodi-Whiteslough SFCF <br /> 12751 N.Thornton Rd <br /> Lodi, CA 95242 <br /> (209)333-6749 <br /> Date of 1KC of IKG Receipt: Total YKG Received: <br /> e ti Grease <br /> Receiving Facility F:ep.Name(Print) OMIT C1 tOC1LC1� (Sb�nature): <br /> Authorized Transporter: Vehicle Decal Number: _ <br /> Stockton Roto Rooter Dirlver Name(print): <br /> —14) <br /> 4228 Newton Rd <br /> Stockton,CA 95205 Driver Signature: <br /> d H6ti 'IN Nd9S :Z SAH 'WPO <br />