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ad aaA 0 <br /> 1911 "o N AVH :0l t [H '5 d uai p <br /> Inedible Kitchen Grease (IKG) Manifest <br /> Stockton Roto Rooter Grease & Septic Service <br /> _� � Manifest#L- <br /> Date: a/ '� Time: ."o?� A1V1/ <br /> Business Name: <br /> Job Site Address: cR�'3Q 677,4W /� Zip Code: ,5 <br /> Customer Name (print): (Signature6. a' <br /> 1KG 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:Time of IKG ReceiptJ5iW Total IKG Received: <br /> Sept _ Grease <br /> Receiving Facility step.Name(Print) - s (Signature) <br /> Authorized Transporter: Vehicle Decal Number: <br /> Stockton Roto Rooter Driver Name(print): J /J'l � <br /> I 4228 Newton Rd / 1 <br /> Stockton,CA 95205 Driver Signature: <br /> ti 'd �L�L 'ON NVOE :O < L [Oz .S add <br />