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_OC�T-799WON NSl : LI0Z 'S 'ASW awil paniaaad <br /> �e W) <br /> Inedible Kitchen Grease (IKG) Manifest <br /> Stockton Roto Rooter Grease & Septic Service <br /> Date: C—/ Time: �O/pm Manifest#L-U24I <br /> Business Nance: 1 o/ <br /> Job Site Address: !a/ ��.ia'1 o�l�G�� Zip Code: 2' <br /> Customer Name (print): zZ (signature): <br /> IKG Authorized Receiving Facility Name/Address (circle dump site for facility) <br /> City of Lodi-Whiteslough SFCF <br /> 12751 N. Thornton Rd <br /> Lodi, CA 95242 <br /> (209)333-6749 <br /> Date of lkG Receipt: 9-60 y 7 Time of IKG Receipt:// ;AS Total IKG Received: <br /> Septic L6rease <br /> Receiving Facility Rep.Name(Print) (Signature),: ' <br /> Authorized Transporter: Vehicle Decal Number: 77s-sr' <br /> Stockton Roto Rooter Driver Name(print): <br /> 4225 Newton Rd <br /> Stockton,CA 95205 Driver Signature:_ i�"'�� <br /> 'd l6SL '°N WdH : z -LIN 'S 'APA <br />