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1189 `IN ME l tiI0 Zl 'end awl paniana� <br /> r—rT <br /> Inedible Kitchen Grease (IKG) Manifest <br /> Stockton Roto Rooter Grease & Septic Service <br /> Date:_ 71 I z '1i-e: _ 'JZA Mswfest#L-On ff-o <br /> Business Name: L66 <br /> �S <br /> Job Site Address:_ ���) I�,r � L P7 Zip Code: <br /> Customer Name(print): ✓ L(Signature): <br /> IKG Authorized Receiving Fae ty Name/Address (circle dump site for facility) <br /> City of Lodi-Whiteslough SPCF <br /> 12751 N.Thornton Rd <br /> Lodi, CA 95242 <br /> (209)333-6749 <br /> Date of lKG Receipt: Time of IKG Receipt: 33 Tonal IKG Recetved;—Z <br /> � <br /> i <br /> Septic Grease <br /> Receiving Facility Rep.Name(Print) <br /> i <br /> Authorized Transporter: Vehicle Decal Number: <br /> Stockton Roto Rooter Driver Name(print): <br /> 0.228 Newton Rd — <br /> Stockton,CA 95205 Driver Sigpaature: <br /> ' f <br /> 92/80 OJdd �GiOO�J OlO�J 9Z69s9b607, T£:ZT PT07,/ZT/80 <br />