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L901 '�N Wd6S l 9l0Z S '°ny ;W1j P;Al ;);� <br /> Inedible Kitchen. Grease (ISG) Manifest <br /> Stockton Roto Rooter Grease & Septic Service <br /> .Date: /1r Time: A.-NI/PM Manifest 9 L- 0�20E <br /> Business Name: _ j <br /> Job Site Address. S. 1 Q Zip Code• g0 <br /> Customer Name (print); 2C[ Ct�f (Signature): <br /> 1KG Authorized Receiviog FacWty Name/Address (circle dump site for facility) <br /> City of Lodi-WhitesloughsWCF <br /> 12751 N. Thornton Rd <br /> Lodi, CA 95242 <br /> (209)333-6749 <br /> Date of IKG Receipt: A& Time of 1KG Receipt; r ' 0.s- Total Y'KG Received: <br /> Septic Grease <br /> Receiving Facility Rep.Name(Print) {�I A� �Q�6P�� <br /> Fj (Signature): <br /> Authorized Transporter: 'Vehicle Decal Number: r4 27.E - <br /> Stockton Roto Rooter Driver Name(pnnt): <br /> 4225 Newton Rd <br /> Stockton,CA 95205 Driver Signatur <br /> 0 d LLS 'ON WdEo : Z 9l0Z 'S '2nd <br />