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1005 '°N OW6 til0l til 'U rt,;WIJ penia0a� <br /> Inedible Kitchen Grease (IKG) Manifest <br /> Stockton Roto Rooter Grease & Septic Service <br /> Date: // Time: Manifest#L-6O3y <br /> Business Name: —I/r � - - <br /> � S h. <br /> Job Site Address: Z' Code: <br /> say <br /> Customer Name(print): �{� �,� (Signature): <br /> IKG Authorized Receiving Facility Name/Address (circle dump site for facility) <br /> City of Lodi-Whiteslough SPCF <br /> 12751 N. Thornton Rd <br /> Lodi,CA 95242 <br /> (209) 333-6749 <br /> Date of IXG Receipt: Time of IKG Receipt: /o'30 Total IKG Received: <br /> Septic _ tease <br /> Receivinge <br /> Facility Rep. Name(Print)_�1r�tJ� C� (Signature): [/ . <br /> Authorized Transporter: Vehicle Decal Number: L'�E Lv Ao <br /> Stockton Roto Rooter Driver Name(print): <br /> 4228 Newton Rd <br /> Stockton,CA 95205 Driver Signature: <br /> 90/50 3Jdd d3iood 0iod 9Z6559b60Z 9V:60 17TOZ/bT/T0 <br />