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l H 'ON ME : [ ti[Oz •zi 'and awil pania3;� <br /> 12 —o Va . <br /> Inedible Kitchen Grease (IKG) Manifest <br /> Stockton Roto Rooter Grease & Septic Service <br /> Date: <br /> Time: <br /> Business Name: 1�P r -1 <br /> Job Site Address: d Zip Code: <br /> Customer Name(print): � - (Signature): <br /> 1KG•Authorized Receiving Faeft Name/Address (circle dump site for facility) <br /> •City of Lodi-vYhiteslough SPCA' <br /> 12751 N.Thornton Rd <br /> Lodi,CA 95242 <br /> (209)333-6749 <br /> Date of lKG Receipt, 3 Time of 1KG Receipt: Total IKG Received: <br /> Septie rease <br /> Receiving FaeilSty Rep.Name(Print) (Signature): 77 . <br /> Authorized Transporter: Vehicle Decal Number: �oZ �J <br /> Stockton Roto Rooter Driver Name(print): ` Z� <br /> 4228 Newton Rd _. '7 /J 1,t L <br /> Stockton,CA 95205 Driver Signature: / <br /> f <br /> 9T/9T 39Vd Jdl00J OlOJ 9Z6559b60Z TE :ZT PTOZ/ZT/20 <br />