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99ti1 ;IN, WdSl :� L l�Ol 'S 'ApW auJil pania3a� <br /> Inedible Kitchen Grease (IKG) Manifest I <br /> Stockton Roto Rooter Grease & Septic Service <br /> Date: — ` Time: . / M Manifest#Y,- I <br /> Business <br /> Job Site Address.. ..`('v��.� Zip C �'1� <br /> Customer Name (pri.nt):�� 1� eOSWA (Signature): <br /> ]KG Authorized Receiving Facility Name/Address (circle dump s' a for cility) <br /> City of Lodi-Whiteslough SFCF <br /> 12751 N. Thornton Rd <br /> Lodi, CA 95242 <br /> (209)333-6749 <br /> Date of WO Receipt:'-1 I ime of 1KG Receipt: Total IKG Received: <br /> Septic ' Grease <br /> Receiving Facility Rep.Name(Print (Signature) <br /> Authorized Transporter: Vehicle Decal Number: <br /> Stockton Roto Rooter Driver Name(print): <br /> 4228 Newton Rd <br /> Stockton,CA 95205 Driver Signatur <br /> 1 <br /> 9 d 16SL 'ON WdH : Z LlR 'S 'A PN <br />