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I911 "N PH :0I LIH 'S 'add n1i pania3;� <br /> Inedible Kitchen Grease (IKG) Manifest I <br /> Stockton Roto Rooter Grease & Septic Service <br /> Date: O —.22— )�1 Time: i AM/PM Mauifest#L-CV,�f <br /> Business Name: Laj, I' ` "L0f-a- <br /> Job Site Address: ??-5 -Se) WtcWff A�-E �gLr Zip Code: <br /> Customer Name (print)• v Signatur <br /> 1KC 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 IKG Receipt: --_)"Z Time of IKG Receipt: r.05 Total IKG Received: d�dn <br /> Septic Grea <br /> Receiving Facility Rep.Name(Prin dsG �v4 (Signature).`C <br /> Authorized Transporter: Vehicle Decal Number- 7_4` <br /> 11 <br /> Stockton Roto Rooter Driver Name(print):_ tJ V J W!V _<0 <br /> 4228 Newton Rd <br /> Stockton,CA 95205 Driver Signature: ,q <br /> 8 'd ELH '°N AVE : oI LIE 'S add <br />