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L901 'ON Wd6S : 1 9102 'S '°ny awil paniaaad <br /> # 3 228 <br /> Inedible Kitchen Grease (IKG) Manifest <br /> Stockton Roto Rooter Grease & Septic Service <br /> 0,,:vc <br /> Date: Time: .� A.NI(Pfl�lanifest g L-sZW <br /> Business Name• 'LEn gcic-/1-Ge <br /> Job Site Address: �(j GcJ d / I-v7 e I/— - Z'W, Zap Code: Y3E. ?yb <br /> Customer Name (print): (Signature): <br /> .EKG 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 1KG Receipt: �� / Time of 1KG Receipt: �" Total tKG Received: <br /> eptic Grease <br /> Receiving Facility Rep.Name(print) Q� <br /> (Signature) <br /> Authorized Transporter: Vehicle Decal Number: <br /> Stock-ton Roto Rooter Driver Name(print): - �` /A/ <br /> 4228 Newton Rd <br /> Stockton,CA 95205 Driver Signature: <br /> Zl 'd LELS 'ON V\JdE0 : Z 9102 'S 'uny <br />