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1199 'IN WdH l tiIOZ Zl 'end awil pa�niaaa� <br /> Inedible Kitchen Grease (IKG) Manifest <br /> Stockton Roto Rooter Grease & Septic Service <br /> Date:, .! D �� Rime: S-a Manifest 9 L-007r <br /> Business Name: Z-ca d' / t lnq 0 e cti rUS I <br /> p <br /> Job Site Address: f 75-- S 9a;T Y ,)1, _ Zip Code: 52�� <br /> T <br /> Customer Name. (print • Si gn.atar <br /> W .Authorized Receiving Facility Name/Address (circle dump site fo facility) <br /> City of Lodi-Whiteslough SPCF <br /> 12751 N.Thornton Rd <br /> Lodi CA 95242 <br /> (209)333-6749 <br /> Date of IKG Receipt-.Z&1 Time of TKG Receipt: Total IK(;Received: <br /> Septi Grease <br /> Receiving Facility Rep.Name(print (Signature): <br /> Authorized Transporter: Vehicle Decal Number: _72t2 I r-) <br /> Stockton Roto Rooter Driver Name(print):_ -/�7 <br /> 4228 Newton Rd rel_ <br /> Stockton,CA 95205 Driver Signature:_ <br /> 9T/50 39Cd N=Dd OiMl 9Z6559b60Z TC:ZT VTOZ/ZT/80 <br />