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l pani <br /> L901 'nN Wd6S l 9lOZ 5 any auiiz�a� <br /> 074 <br /> a� <br /> Inedible Kitchen Grease (]KG) Manifest <br /> Stockton Roto Rooter Grease & Septic Service <br /> Date: Time: AM/ji�FiVlanifest#L- 6,:2- <br /> Business <br /> ,:2-Business Name: <br /> Job Site Address: :LQ 7 S - Zco i jcC � zip Code: � <br /> CustonaerName (print): firea�' C' ►PS (Signature): 9 W <br /> IKG Authorized Receiving Facility Name/Address (circle dump site for facility) <br /> City of Lodz-Whiteslough SPCF <br /> 12751 N. Thornton Rd <br /> Lodi, CA 95242 <br /> (209) 333-6749 <br /> (Date of tKG Receipt:�_7��o Time of IKG Receipt.`? i Total IKG Received: <br /> Septic Grease <br /> Receiving Facility Rep.Name(Print) 4 K:) <br /> (Signature): <br /> Authorized Trnusporter: Vehicle Decal Number:_ / <br /> e <br /> Stockton Roto Rooter Driver Name(print): <br /> 4228 Newton Rd <br /> Stockton,CA 95205 Driver Signature:_ <br /> 'd LLS 'ON Mo : z 91H 'S '.ny <br />