ARCHIVED REPORTS_PUMP RPTS 2015 - Laserfiche WebLink

Home Browse Search

5T'ATL--T CA1..IFORNLk )��6 '°N WdtiO Ol SIOZ 'l � 'dlS ;Wli paAia°a� DEPARTMENT OF FOOD AND AGRIEUTTURE, Meat,Poultry and Fgg Safety Branch . � 1??0,N Street Manifest NC):: Sacramento,CA 95814 ' (916)900-5004 i 79-124 (Est 11/12) Manifest - luedihle Kitchen Grease Tani spolrt C� Instructions and Recelviug-f aeTty Information [ A complete Inedible Kitchent>rease G)Transport ADinifest for a<load of IKG consists of this form and all generator copies from MPES••I+orm 79-125(Mau fest-Inedible Kdtchen Grease Transport, Generator Information)for generators that cdt(tribtilte 1KG to the-load. Altematiyely,the IKG transporter may use other forms that contain all required information. AR forms'mi each m,"t must I 'have the same A anilfest Number. Transporters must keep completed•inani£ests for-two year. Manifest Instructions: 1.The driver of the IKG transport vehicle is responsible for entering all information on this form and on MPES Form 79- .125, Manifest-Inedible Krtehen Grease Transport, Generator lnfounation,except for in the Receiving Facility Representative and Generator Representative name and sig ature boxes' All entries must be in ink and legible_ The � driver must initial any corrections-to 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 y facility at the time of IKG receipt or mail or deliver the copy to-the receiving facility within-15 work.days_ �t 3. Enter the Manifest Number found at the top bf this form in the Manifest:No. box.on the generator farm(MPES Form 79- j 925)for each generator that contributes to the Ioad. Ali ggnegaiWforms.from generators where IKG was collected to make up the load must have the same Manifest Number as the attached Receiving Facility Information form. f 4. Give the generator copy from MP FS Form 79-125)to the generator at the time of lKG collection or mail or deliver the copy,to the generator within 45 calendar days- 5.Attach the gener4tor forms (MPES Form 79-125)for all generators that contributed to the load of EKG to this form. Maintain this form and the attached denprator forms for two years from the date on this form. Date of lKG Receipt Time of 1K13 Receipt Type of �] Used Cooking Oil 1 i r ��j AN1 PM lKQ,/ nte=ptorJrrap Grease •'7 Fieceiimrg Facility Name: Receiving Fac*Addr1rS9'--- otal IKG Received: Measuring Method Used: Conbiraer Volume' f required): Percentage Fill(if Required): Gallons b Pounds Re stared Transporter Name: Vehicle Llecal Numbers Driver Mame(Printed): Receiving Facility Representative N~ a(Printed); I � �. Cj , privet Signature: ReceiviSignature:' Receiving Fa epresen +' I. Cj 'd ONE 'ON Wv90 :o < S l OZ [ � 'd as f�