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L9 WI N AdOS : O 9l0Z 'Z ( 'd;S ;Wli pania3;� <br /> ��(o-7 � 1 . <br /> Inedible Kitchen Grease (IKG) Manifest <br /> Stockton Roto Rooter Grease & Septic Service loop COZ17W <br /> Date: Time: ' O, / lIahifest#L-O � <br /> 1 f <br /> Busiuess Name: i` l I� <br /> Job Site Address: i Zip code, ���7 f <br /> CustOUter Name (print): (Signature): <br /> 1KG Autborized Receiving Facility Name/Address (circle dump site for facility) <br /> City of Lodi-`Vhiteslough$WF <br /> 12751 N. Thorntou Rd <br /> Lodi, CA 95242 <br /> (209)333-6749 <br /> Rate of IXG Receipt- / Time of IKG Receipt: 2• Total IKG Received: <br /> eptic Grease <br /> Receiving Facility Rep.Name(print) � � <br /> Receiving tY P (� ) (Signature): <br /> Authorized Transporter: Vehicle Decal Number: Zx�Z— <br /> Stockton Roto Rooter Driver Name(print): Ey2&2a <br /> 4228 Newton Rd <br /> Stockton,CA 95205 Driver Signature: <br /> S 'd tiS6S 'ON AdIS :� 9 [0Z 'Zl 'daS <br />