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L 6 9 L 'oN NSI l tiI0 0 aW J Pani a3a� <br /> Inedible Kitchen Grease (IKG) Manifest <br /> Stockton Roto Rooter Grease & Septic Service <br /> Date: 1'ipa�e: _W / <br /> -- _ / PNb1 anifest#L-6) <br /> Business Name: <br /> ,lob Site Address:-32/----L'.- 71-e rr ez- Zip Coder el� <br /> Customer Name (print): �, (Signature): <br /> 1KG Authorized Receiving Facility Name/Address (circle dump site for facility) <br /> City of Lodi-Wluteslough SPCF <br /> 12751 N. 'Thornton Rd <br /> Lodi, CA 95242 <br /> (209) .333-6749 <br /> Date of JKG Receipt: of IKG Receipt: Total IKG Received: <br /> Septic reale <br /> 9 <br /> Receiving Facility Rep.Name(Print) 'll(w�l n. (Signature): <br /> Authorized Transporter: Vehicle Decal Number: <br /> �t% <br /> Stockton Roto Rooter Driver Name(print): [�[ �z �( 1 tcUr12-) <br /> 4225 Newton Rd <br /> Stockton,CA 95205 Driver Signature: — .a <br /> 9 'd 90LO 'ON �dtZ l �IOZ l l ,�a0 <br />