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1005 "N Wd :6 ti[OZ 'til 'U�r awi j paniaOq <br /> Inedible Kitchen Grease (IKG) Manifest �� a a <br /> Stockton Roto Rooter Grease & Septic Service 3 <br /> Date: Time: ,' AM/PM Manifest#L- 3 2— <br /> Business Name: Op, <br /> Job Site Address: (r�L Z' e: �( <br /> Customer Name (ftt:: <br /> �- (Signatur <br /> 1KG Authorized Receiving Facility Name/Address (circle dump site f facility) <br /> City of Lodi-Whiteslough SPCF <br /> 12751 N. Thornton Rd <br /> Lodi, CA 95242 <br /> (209)333-6749 <br /> Date of IKG Receipt.y� 3 Time of 1KG Receipt: Total IKG Received: <br /> Sept' � <br /> Receiving Facility Rep.Name(Print)4a�4--(-�- igaature):_L-A/ <br /> Authorized Transporter- Vehicle Decal Number: <br /> Stockton Roto Rooter Driver Name(print):_ fZoma ' <br /> 4228 Newton Rd <br /> Stockton,CA 95205 Driver. Signature: <br /> l <br /> 90/60 39dd �Gioo�f 0iod 9Z6559b60Z 9b 60 VTOZ/bT/Z0 <br />