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H1L 'ON WEl �I0 '0E 'daS awil paniaaa� <br /> P9 <br /> Inedible Kitchen Grease (1KG) Manifest <br /> Stockton Roto Rooter Grease & Septic Service <br /> Date:_ '. -�o' 'i'iime: ')O AM j* M ti fest <br /> y <br /> I <br /> ' •I <br /> Business Name: P� ,f S w-S <br /> fob Site Address: Z Lt,��� Zip Coder <br /> Customer Name(print): <br /> IK6 Authored Receiving Facilfty NanWAddrm (circle dump site fok facility) <br /> • �I <br /> 'Cid'of Lodi-VAiitalongh SPCF <br /> 12731 N.Thornton Rd :I <br /> Lodi,CA 95242 <br /> (209)333-6749 <br /> I <br /> Date of 1KG Receipt: Time of UCG Rec4pt:o "7� Total XKG Rived; /� I <br /> I <br /> Seplxc Grease <br /> lLeceivia�g Fae tty Rep.Name(Krim) <br /> Authorized Transporter: VWde Decal Number: <br /> Stockton Roto Rooter Driver Na me(print): ' <br /> �', <br /> 4228 Newton Rd <br /> Stocktuu,CA,95205 Arfver"Signature: 'j <br /> I <br /> - f <br /> :I <br /> °i <br /> i <br /> • I <br /> VT/OT 39tid Z13100�1 01021 K6559b60Z 96:6Z PTK/06!60 <br />