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1. .J1 <br /> �61L '°N Wdti� Z tiIOZ 'OE 'das aril pzA i�azo <br /> SCATS q CALIFORNIA 9 <br /> DUARTMENT QF TMD5 AND OATM=77M1 <br /> Moat,Poulny and Egg Safcry Branch Manifest No.: - <br /> 1220 N Strcct <br /> SaG#ffilRStA,CA 95814 <br /> 916 9005004 /-77 <br /> !' a <br /> 79-124 (Est.11/12) <br /> 11+ia�itfes#.- <br /> Inedible Kiitchen G�-eage Trsiiais�ort <br /> ' mor mat><on ; <br /> Inst�>nrs and Receiv�g.Facit�t� i <br /> �,A complete loodillb Kit6em rme-�)T`rawPort MBRUest for a load of IKG consists of this form <br /> and all generator couples from PVM^Form 79-125 (Maioideat Inedible WIftbeln Grease Transport, <br /> Generator Information)for euerator`s'tit r�itrfbm EKG tothe liosrd. Atternattfveity,the IKG <br /> transporter may use other forms that contain all regnired i7nformstiolQ. AU forma in each manifest must ,y . <br /> "Have the same MaWest Number. Transporters•must lip cep ad fmiuffests for two years., <br /> + 1 <br /> Manifbst Instructions: <br /> ble for enteriag all infom;ation.on this form and on MPES Form 79- <br /> 1,The driver of the IKG transpcit vehicle is r�orxsl <br /> 175, Manitbst-Inedible Ktctm Grease Trarsspor>r <br /> Generator-;nforla�,axcept for in the Receiving Facility <br /> nehlre boxers. Afl entries must be in ink and legible. The <br /> Reprawntativve and Generator F2epKaser>tative narne;and sig <br /> driver must initial any corrections to infarlr AW alteady,enUmd. q <br /> form to the receiving <br /> 2. Eller all information in ft <br /> below for ctn„load of IKt3„; Give one!SPY of fire campteted 9 <br /> fac�lity 6t the time of IKG reeW or mall or deriver the cagy iior emlar ytwithin 5 workdays. <br /> 3. Enter the Manliest Number found at the top bf t ft form in the Man”No. box;on the gerxmAor form(MPES Form 79- <br /> 125)for each generator that a�nWbutes tri the toad. Ail gemrat forms.from Senerat�a <br /> where IKG was collected to <br /> make up the k)ad must have the same Manifest Number as the aaadfed Recelvtng Facility Information form. <br /> i <br /> 4. Give the generftr copy(from MPES Form 79-125)to ti►e ggneratar at the time of IKG collodion or mall'or deliver the r <br /> copy to the generaabar within 45 c$lendw days. <br /> E '1�j <br /> S.Attaoh,t%generator forms(MPES Form 79-125)for all Senerator$filar contributed to the toad of IKG to this form- <br /> Maintain aria form end the attacheQ gerwatar torms for two years from the dabs on t1 iis`torrri. <br /> Of CA IKO Receipt TYM <br /> Used CO*h g ONcl <br /> F+ <br /> Y Z . O <br /> AM PMIKG: /TntorcegWrrrap Grease <br /> Racsfvft 71cW <br /> F AddrenW." <br /> ami IKG ,Meewd UsW: Coi+tpinervolume-(n Requites: FM(N>aiu!e ): <br /> ❑ Pwnds <br /> Vehh:bs Decal Number. <br /> Q6 �S NWTW 1 <br /> t I <br /> re: <br /> JR7 nF, <br /> R�Slgttstvte: <br /> r= ;ji <br /> VT/ST lie"d ZtoiooJ OlOZI KGSS9b6Oz 96 6T PTH/OCE/60 <br />