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HSCIN WdOti:E �[OZ 'll -ACN aWl j pania3;� <br /> Inedible Kitchen Grease (IKG) Manifest <br /> Stockton Rota Rooter Grease & Septic Service <br /> Date: <br /> J `� Time. / JN Manifest 9 L- <br /> 2 <br /> Business Name: at <br /> ,lob Site Address:- -]2?1S 7 C. C - -.��-c` - -Zip Code: <br /> Customer Name (print): (Sivatuare)r <br /> 5 <br /> IKG Authorized Receiving,Facility Name/Address (circle dump site for facility) <br /> City of Lodi-Whiteslough SPC)a <br /> 1.75). N. Thornton Rd <br /> Lodi, CA 95242 <br /> (209) 333-6749 <br /> Date of IKG Receipt: Time of TKG Receipt: Total 1KG Received: <br /> 1 ��— <br /> SepticCre:as <br /> Receiving, Facility Rep.Name(Print) ( ) � <br /> Si �ture <br /> Authorized Transporter: Vehicle Decal Number. <br /> Stockton Roto Rooter Driver Name(print): <br /> 4225 Newton Rd <br /> Stockton,CA 95205 Driver Sibnature <br /> L 'd z �H 'ON Wd2ti :� ti�Oz '< < 'AON <br />