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L69L '°N AdSI : l ti[OZ 'll ')a0 ;Wli Pani ;);d <br /> � <br /> r <br /> [2- - <br /> Inedible Kitchen Grease (IKG) Manifest <br /> Stockton Roto Rooter Grease & Septic Service <br /> Date: Time: PM Manifest#L-- ( L <br /> Business Name: <br /> Job Site Address: M j 1 Zip Code. <br /> Customer Name (print): (Signature)- . <br /> I KG Authorized Receiving Facility Name/Address (circle dump site for facility) <br /> Cite of Lodi-Whiteslough SFCF <br /> 1.2751 N. Thornton Rd <br /> Lodi, CA 95242 <br /> (209) 333-6749 <br /> Date of lKG Receipt:� Time of Tl{G Receipt: Total YKG Received: �J <br /> Septic ) Grease <br /> Receiving Facility Rep. Name(Print) <br /> Authorized Transporter: Vehicle Decal Number: <br /> Stockton Roto Rooter Driver Name(print): ��C>\f_iJf �( j7 X,t�-. <br /> 4223 Newton Rd �y 1 <br /> Stockton,CA 95205 Driver Signature:—� <br /> Z 'd 90LO 'ON ti10Z <br />