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-' �ZSLON WdOti tiIOZ ll 'AON ;Wli paAI ;3;� <br /> s"CATE,OF CALIFORNIA ' ' <br /> DEPARTMENT OF FOOD AND AGRICULTURE <br /> A <br /> Mesa,Poultry and Egg l3ranckt <br /> Safety ,......,..,..._..._._... ., .. - -' <br /> 1220NStreet Mian'If <br /> est No:: <br /> Sacramento,CA 95314 <br /> (916)900-5004 �%`' ,, ✓` S <br /> 79-124 (Esc.11112) }' <br /> , <br /> Manifest - .Inedibe Iifcbie>n,G>rease Transport <br /> Instructions and Rece y ng-Facility Information <br /> 'A complete inedible G) Transport Manifest for a load of IKG consists of this forKitcheir>E;,GreaSe m <br /> .and all generator copies froni MPFS-Torm 79-125 (Manifest-Inedible Kitchen Grease Transport, <br /> Generator Inforniatioiu�for gead=toai-s'thiatcontrzMWte WG 0 the"load Alternatively,the IKG <br /> transporter may use other forms that contain all required information. All forms in each manifest must <br /> have the same ManiliestNelimber. Trans o"' =j <br /> p rters'mns keep.-' .:,manifests for tfvo years: <br /> Manifest Instru(%ons: <br /> '1. The driver of the IKG transport vehicle is responsible far entering all information on this form and on MPES Form 79- <br /> 125, Manifest-Inedible Kltehen Grease Transport;-Generator.information, except,for in the Receiving Facility <br /> Representative and Generator Represenfiative name and signature boxes. All entries must be in ink and legible. The ii <br /> 'driver must:initial.any corrections to information already-entered i <br /> i2. Enter all information in the form below for each load of IKG. Give one copy of the completed form to the receiving 1 <br /> faciiiy'at the time of IKG receipt or mail or deliver the copy to the receiving t4cillty within 15,work,,days. <br /> 3. Enter the Manifest Number found at the,tog of this form in the Manftst No. bax,on the generator form(MPES Form 79- <br /> 125)for each generator that contributes to the.loaO.' All 9enerptorforms from generators where IKG was collected to a <br /> make up the load must have the same Manifest Number as the attached Receiving Facility Information form_ <br /> 4. Give the generator copy(from MPES Form 79-125)to the generator at the time of IKG collection or malt'or deliver the <br /> copy to the generator within 45 calendar days_ <br /> 5.Attach the generator forms(MPES Form 79-125)for all generators that contributed to the load of IKG to this form. ' <br /> Maintain this form and the attached generator forms for two years from the date on this form. <br /> =i <br /> F)aWO Receipt Time of IiCG Receipt <br /> Type of ❑ Used Coalung Oil 7 <br /> 9 t <br /> i AM PM IKG: Irderceptoi/rr p Grease <br /> atuity Name: <br /> Fteceiving FacalityAddress`:".­— ro. <br /> yl <br /> Total 1KG Received: Mwsiuring Metfi6d Used, Container Volume'(If uired): Percentage Fill(if Required <br /> allons ) <br /> _� <br /> ❑ Pounds <br /> _3 <br /> «<< <br /> Registetad Transporter Name; Vehicle Decal Number_ <br /> 53 <br /> Driver Name(Printed): Receiving Facility.Representative Name(Printed): ; <br /> Driver Signature-. R ' n Fatuity Representative Signature: 1 <br /> ,,/.9 'd�[H N WdCti tiIOZ lfl N <br />