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awil paniaD;� <br /> L69L '0N=WdSI l ytilOZ 'll '�aQ <br /> Inedible Kitchen Grease (I G) Manifest <br /> Stockton Roto Rooter Grease & Septic Service <br /> —,� <br /> Date: f•' 'T'ime: <br /> `f <br /> Business Name: ARo—sPlo��jv <br /> Job Site Address. y,d,�, - `� Zip Code:Kr,;2 <br /> Customer Name (print): (Signature): <br /> 1KG Authorized Receiving Facility Name/Address (circle dump site for facility) <br /> City of)Jodi-IMaiteslougb SPCA' <br /> 12751 N. Thornton Rd <br /> Lodi, CA 95242 <br /> (209) 333-6749 <br /> Date of WG Receipt:1!-,24-j4Time of 1KG Receipt: _ Total 1KG Received: <br /> Septicgalea <br /> Receiving Facility Rep.Name(Print.) M(�, (Signature)- ' <br /> Authorized Transporter: Vehicle Decal Number: . <br /> Stockton Roto Rooter Driver Name(print): <br /> 422$Newton lid �q <br /> Stockton,CA 95205 Driver Signature:--- <br /> d 9600 'ON 'O;C <br />