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[ [99 "N nd aUJ i paA i a3 STATE OF CALIFORNIA DRI)AR 1 MN-f OF FO D AND AGRICULTURE 'Meat,Poalty and Egg Safety Branch Manifest-No.: v2-Ol 5 1220 N Street Saor=ento,CA 95814 ;y=: (916)900-5004 :. 7$424 (Est 11/12) {: r �... Magfest ='1ne� c�i'en Qree3iransport , _ CMt Instraction�s and Reeeiviing Facility Information A complete Inedible Kitchen grease PKQ)Transport Manifest for sload-of IKG consists of this forms and all generator copies from MPESTolrm 79-1.25(Manifest Inedibt, le Kitchen Grease Transpor ' Generator Infor action)for generators that Ontribt1te IKG'to the load. Alternatively,the]ISG, transporter may use other forms that contain all required information. All forms in each manifest must have the same Maniles>t;Number. Tlransporters must ke g cc►�ipleted^x+aaauifests for two years.. Marlifest lhsfruetions: 1.The driver of the IKG transport vehicle is responsible for entering all information on this form and on MPES Form 79- 125, Manifest-Inedible Kitchen Grease-Transport"GeMrator I007.Pati9cl,except for in the Receiving Facility Representative and Generator Representative naive'and signature,boxes. All entries must be in ink and legible. The driver must-initial.any coons to Information already,entered: 2. Enter all information in the form below for each load of IKG. Give one copy of the completed form to the receiving facility the time of°IKG tempt or maif-or deliver the copy trj.ttle r�eceiving;facII4withirr-1OV rlc.days. i 3. Enter the Manifest Plumber found atthe,to p 0this.form in the Manifest No.,box on the,generator form (MPES Form 9- 125)for each generator that c�onfxibutes. O the.�oad:"Ali generator forms from.generators where IKG was collected to make up the load must have the same Manifest Number as'the attached'Receiving Facility information form. 4. Give the generator copy(from MPES Form 79-125)to the generator at the time of7KG collection or mall'or deliver the copy to the generator yrithin 45 calendar days. _ 5.Attach the generator forms(MPES+orm 79-125)for all generators that contributed tD the load of IKG to this form. Maintain this form 2nd the attached-generator forms for two years from the date on this f0rTn- OfKG Receipt Tone of IKG Receipt: Type cf Q Used Cooking Oil EN IKG: � Irtbe+ceptorlTrap Grr?'ase Rewmrig Fat'lity Name: Receiving Faolib-Mdres�" . . . 'ham 7 / P oral IKG R S+red: Mea nrtq Method llsi?d: Corka r Volume I�Required): Percerrtiage Flli(If required): Gallons �f p Pounds /off' ,� � CIO Decal plumber. ',F r orterNam�: f� rr J , ktson JJ� D Driver Name(Pth+ted): Receiving Facirrby RepreSentatve Name(Pdntt:U: Driver Signature: Receiving Famay Representative signature: 9T/Z10 39-vd i'I=od oioij 9z6559b60z Tc zT btez/zz/se