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HSCIN AdOti : � tiI0 ll -AON ;Wli P;AI ;3;d <br /> (2-4 4S <br /> Inedible Kitchen Grease (I-K.G) Manifest <br /> Stockton Roto Rooter Grease & Septic Service <br /> Date: - ( 0 7 r �1 Time: r 161,GVl PM Manifest-4 L- <br /> -1 9 2 t'-% <br /> Business Name: inr-L ��„ r�j <br /> Job Site Address. 6 4 Zip Code: <br /> Customer Name (print)- nature)� <br /> 1KG Authorized Receiving Facility Name/Address (circle'dump site for facility) <br /> City of Lodi-Whiteslougb SPCF <br /> 12751 N. Thornton Rd <br /> Lodi, CA 95242 <br /> (209) 333-6749 <br /> Date of 1KG Receipt:t 0-7-/7 Time of TKG Receipt. I Total lKG Received: <br /> SepticLGrease <br /> .,6 <br /> Receiving Facility Rep. Name(Print) 11 nrf zL::) (Signature): <br /> Authorized Transporter. Vehicle Decal Number: <br /> Stockton Roto Rooter Driver Nam e(p ri nt);_ <br /> 4228 Newton Rd <br /> Stockton,CA 9520--5 Driver Signature: <br /> '3 <br /> 'd 61H 'ON ML :E tiI06 l l 'AON <br />