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1199 '0N ME 1 tiI0 Zl '2ny amij paniaa; <br /> Ll <br /> Inedible Kitchen Grease (IKG) Manifest <br /> Stockton Roto Rooter Grease & Septic Service <br /> Date:• �7 lime; Manifest#.L-�f6 <br /> Business Name: // IL 4' <br /> Job Site Address: 7 •� . ' ✓ Zip Code: <br /> Customer Nam+ (print): (Signator <br /> HW Authorized Receiving Facility Name/Address (circle dump site for facility) r <br /> •City of Lodi Whiteslough SPCF <br /> 12751 N.Thornton Rd <br /> Lodi,CA 93242 <br /> (209)3 33-6749 <br /> / Time of 1KG Receipt. Total IKG Received; <br /> Date of IKG Receipt: .P • — ------ <br /> Septic �rease- <br /> Recelving <br /> Facility Rep.Name(Priv (Signature): <br /> Authorized Transporter: Vehicle Decal Number: <br /> Stockton Roto Rooter Driver Name(pri�at): <br /> 4228 Newton Rd <br /> Stockton,CA 95205 Driver Sim <br /> ' f <br /> l <br /> 9T/ZT ��J�d a=O1 j 0101 9Z6559b60Z Tc' :ZT PT07,/ZT/80 <br />