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�61L '�N Wdb� l �[OZ '0E dag ;W 1i paniaaa� <br /> i . <br /> Inedible Kitchen Grease (IKG) Manikst <br /> Stockton Roto Rooter Grease & Septic Service .r <br /> �1 <br /> I <br /> Date... - Ame. AMOA est <br /> i <br /> Business Name: <br /> i <br /> Job Site Address: u{YC ) L,s� �4A ELA-e f- ip C e� j <br /> I <br /> Custoiner Name(print): n' (Signature): <br /> :I <br /> IKG Authorirxed It es <br /> eedving Faaffity NamdAddrs (chvle dump site foir facility) <br /> City'of 1od1-VAdte81oa9h SPCF <br /> 12751 N.Thornton Rd <br /> Lodi,CA 95242 <br /> (209)333-6749 'I <br /> Date of TKG Receipt:YiY_NTime of lKG Reeelpt: Total-KG Received: <br /> A <br /> •I <br /> Septic reuse <br /> .i <br /> ReceMng Facility Rep.Name Q"W) (Slgnatnre): <br /> Authorized Trmuporter: -Vehicle Decal Number. �'jL� � { <br /> Stockton Roto Rooter Driver Name(print): ' 1 <br /> 4=Newton Rid -- <br /> Stockton,CA 95203 Drlver•Signatare: <br /> f a <br /> ?I <br /> • °i <br /> .I <br /> •i <br /> 17T/60 39dd �tolMi 0101 9Z6559b60Z 96:6T VTOZ/06/60 <br />