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ZP.r OZif4L901 'ON Nd 6S l 9102 'S `1V 1w1i paniaaad <br /> Inedible Kitchen, Grease (EKG) Manifest <br /> Stockton Roto Rooter Grease & Septic Service <br /> /� <br /> Date: . � Time: / ��AlY1/ M Manifest#x,-6-,20elll <br /> Business Name: u <br /> Job Site Address: 14 , L��` Zap Code: <br /> Customer Name (print): �i� zt �(Si�ruatgre): <br /> 1KG Authorized Receiving Facility Name/Address (circle dump site for facility) <br /> City of Lodi-Whiteslough SPCA' <br /> 12751 N.Thornton Rd <br /> Lodi,C.A.95242 <br /> (209)333-6749 <br /> Date of]ICG Receipt: Time of 1KG Receipt: A0",Notal rKG Received: ( �`-' <br /> Septic Grease <br /> Receiving Facility Rep.Name(Print)B D 4lTC� ignature): <br /> Authorized Transporter: Vehicle Decal Number- <br /> Stockton <br /> umberStockton Roto Rooter DdverName(print): rcr : <br /> 4228 Newton Rd <br /> Stockton,CA 95245 Driver Signature: <br /> 'd LLS 'ON WdN :: 91H 'S 'end <br />