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IEL� "N Wd [O :Z E1Z '0l '0aauail pania3a� <br /> Inedible Kitchen Grease (IKG) Manifest <br /> Stockton Roto Rooter Grease & Septic Service <br /> Date: Z/"1 2"�� Time: ,�U� AM�. M Manifest#L- Q D 3 Q <br /> Business Name- --W <br /> d b4e I <br /> 117 <br /> �7 <br /> Job Site Address: off, Z ��� ./�� � {�/y� Zip Code; <br /> Customer Name (print): G4-Ax5- (Signature): <br /> i <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 /> � cI <br /> Date of 1KG Receipt:l ��zf�3ime of IKG Receipt: otal IKG Received:—Z5--CU <br /> Septic Grease <br /> Receiving)Facility Rep.Name(print) (Signature): <br /> Authorized Transporter: Vehicle Decal Number: <br /> Stockton Roto Rooter Driver Name(priut): Jlk O� <br /> 4228 Newton Rd <br /> Stockton,CA 95205 Driver Signature: <br /> VO/60 39dd a3100d 0101 9Z6999b6OZ TO:VT 6TOZ/0T/ZT <br />