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ani <br /> pp- p25- 1 L901 "N Wd6S : l 9102 'S °ny a-,Ii paaad <br /> Inedible Kitchen Grease (IKG) Manifest • �j�� <br /> Stockton Roto Rooter Grease & Septic Service <br /> Date_ 711y / Time: I PVI Manifest 4 L- O O <br /> Business Name: <br /> Job Site Address: Zip Code: So7�a <br /> Customer Name(print): b I (Signa e- . <br /> IKG Authorized Receiving Facility Name/Address (circle d1imp site for facility) <br /> City of Lodi-`Vhiteslough SPCF <br /> 12751 N. Thornton Rd <br /> Lodz, CA 95242 <br /> (209)333-6749 <br /> Date of 1KG Receipt:7 Time of IKG Receipt: Total IKG Received: <br /> Septic cease <br /> Receiving Facility Rep.Name(Print)R�1 �rsbP (Signature): <br /> Authorized Transporter: Vehicle Decal Number. / G �/ <br /> Stockton Roto Rooter Driver Name(print): s - ?" <br /> 4228 Newton Rd <br /> Stockton,CA 95205 Driver Signature: <br /> 'd LLS "N Wd�0 : 6 9102 'S 'qnd <br />