Laserfiche WebLink
E6lL °N O '0� daS au11 P <br /> a <br /> nia a� <br /> STATE ..� .. F <br /> DEPARTMZNT OF FOOD AGRI <br /> Mtn Poultry and Egg Safety Br=h � \ <br /> 1220 N Strm Manifest No:: <br /> Sa"amettoo,CA 95814 <br /> (916)900.5004 .,. <br /> 79-124 (FA i l/12) <br /> Mit - lned><We Kitchen) Grease Traait <br /> Instsport <br /> qs"s and RecFacility Ix>I o1r><na ion <br /> pA complete In, L`blc Kitcfie>g` l ae Transport Manffest for a load of IKG consist of this form <br /> smd all goners 'r copies from ^Form 7 -125(Manffest-Inedible Kitchen Grease Transport, <br /> -Generator 1nf6rr!at16>a)'f0'r gedimtors iW6%t%Qte IKG td the'load.. Afternttvely,the IKG <br /> ;"naporter may use other forms that contain an regaire�iinformaUon: All foam in each manifest must i <br /> Isve the same Manifest Number. T . .. . itersmust <br /> 'iata.>aMests ffor.t*o years. <br /> Manf at lhstructions: <br /> 1.The driver of the IKO transport vet, is resporlsrble for elitering all Information on this Palm and on MPES Form 79- <br /> :125, ManN ee-Inedible fGbchen Grease Transport; irftr49tion,except for in the Receiving Facility <br /> Representative and Generator aep,ww' itive name orad s4"ii&Wre boxes. All entries mast be In Ink and legible. The <br /> driver must Inift any corrections toizr�OnAlrqudy jer� 1 <br /> 2. Ether all Oftmation In ft ftum below-for ems:[ped of 1KO. Give ons.$pyy of mpkAed form to me receiving i <br /> at ttft6e df he tKG <br /> ftSi� ... r`eteipt ar rroaAi or deliver the copy to the ' work days. i <br /> 3. Enter the Manifest Number found at tl B,tDp,iofalis form in the ManoEe No. box,on the generator form(MPES Form 79- <br /> ..125)for each g0n rte.tha#6rltrihutes to tttp.load. 'An gener_etor forms from gertergtc+ra where IKG was collected to <br /> raske up the load must have.the same Manifest Number as the ettached Receiving Facility Information form. <br /> i' <br /> 4.Give the gertetator copy(from MPES Form 79-125)to the generator at the time of IKG collection or mailor deliver the <br /> 'Copy to the genor*v witi'lln 45 calendar days. <br /> 5.Attach thei <br /> gersecaDor forrrra(MPES Form 79-125)tnr all generators that contributed to the load of IKG to this farm. <br /> Maintain Itis form-and tete ached gerovtor forms for two years from the date on this form. <br /> Of fKG lkm of KG Reewr�W of I <br /> Used Cool N oil j <br /> �� pM iKf3: �rnercxptor/Trap Grosse it <br /> !! 7 1 <br /> R*Wvft_Fa&*Nor^- P., <br /> ✓l � , �'-i <br /> Jul <br /> OW eco we rwd: � LUOUnd used: corftmer vok n@ Requ lPerCWUQO Fm(If Required): 4 <br /> Pounds AS <br /> o �z <br /> Tom *NwrwYOhiCis Detsl Number.db,,,, <br /> �c1D <br /> F <br /> VT/TT 397d HliooZ1 0iod 9Z6559b6aZ 9E. :9T bTBZ/�c/68 <br />