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tE8t '°N Wdti0 :9 S10�,,j 'S 'upr aWa j pane a);Z <br /> I <br /> I <br /> Inedible Kitchen Grease (IG) Manifest RECEIVED <br /> IV , <br /> Stockton Roto Rooter Grease & Septic Service JAN 0 6 2015 <br /> ENVIRONMENTAL HEALTH j <br /> PERMITISERVICES <br /> Dater— --J - / Time: PM Manifest A LW <br /> Business Name: <br /> Job Site Address: fr �`� :�_ i1 c/ tick Zip Code: <br /> Customer Name(print): 1 . `� ll��°� (Signature): <br /> l <br /> IKG Authorized Receiving Facility Name/Address (circle dump site for facility) <br /> City of Lodi-Whiteslough SPCF <br /> X27,5X N. Thornton Rd <br /> Lodi, CA.9542 <br /> (209)333-6749 � <br /> Date of xKG Receipt: �'0 Time of TTZG Receipt: <br /> Total IKG Received: ej�I <br /> �rSeptic Grease <br /> i <br /> Receiving Facility Rep. Larne(Print) Signature): <br /> Authorized Transporter: Vehicle Decal Number: <br /> Stockton Roto Rooter Driver Name(print): <br /> 4228 Newton Rd <br /> Stockton,CA 95205 Driver Signature: �.�i�' � <br /> s <br /> c! <br /> 'd SZ60 'ON Wd�l j SI06 'S fr <br />