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LUL "N WdW9 S[0 'ur awil pania0ad <br /> Inedible Kitchen Grease (IKG) Manifest <br /> Stockton Roto Rooter Grease & Septic Service <br /> J <br /> Date: /� "I/ / Time: / %P1VI Manifest#);- / U ' <br /> Business Name: 'r.-o q z— ;s �s <br /> .lob Site Address: �2�13D L&) , Z,�" Zip Code: <br /> Customer Name (print): ` .� r3� �5 (Signature): <br /> IKG Authorized Receiving Facility Mame/Address (circle dump site for facility) <br /> City of"Lodi-Whiteslough SPCli <br /> 12751 N. Thornton Rd <br /> Lodi, CA 95242 <br /> (209) 333-6749 <br /> l/[/ <br /> Date of 11CG Receipt. 'V-//-/;?Time Time of[ICG Receipt: Total Yl{G Received: � <br /> Septic Grease <br /> Receiving Facility Rep.Name(Print) lk f (Signature): - <br /> Authorized Transporter: Vehicle Decal Number: <br /> Stockton Roto Rooter Driver Name(print)• c. 1 <br /> 4228 Newton Rd <br /> Stockton,CA 95205 Driver Signat <br /> ti 'd SZ60 '°N Wd� l 9 SIOZ S upf <br />