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L901 "N MS : [ 9l0Z '9 any aril paniaaa� <br /> Inedible Kitchen Grease (KG) Manifest <br /> Stockton Roto Rooter Grease & Septic Service <br /> r ,� <br /> Dater 2 70 'E'irae: AM/! M Manifest#L- <br /> business Name: ' �..J�� �,(' e 5A- <br /> Job Site Address: �ICI� Zip/C de: <br /> Customer Name (print): (Signature): <br /> EKG Authorized Receiving Facility Name/Address (circle dump sit or a ility) <br /> City of L' odi-Whiteslough SPCF <br /> 12751 N. Thornton Rd <br /> Lodi, CA 95242 <br /> (209)333-6749 <br /> Date of IKG Receipt:-)-�-��Time of IKG Receipt: LQ1-2-L4Total 1XG Received.Dio 4 U' <br /> Septic rease <br /> Receiving Facility Rep_Name(Print) k:1(Signatur <br /> Authorized Transporter: Vehicle Decal Number: �_ <br /> Stockton Roto Rooter Driver Name(print): <br /> 4228 Newton Rd <br /> Stockton, CA 95205 Driver Signature: / <br /> U YVl kz cti d f" <br /> z 'd L�L9 'ON Wdz0 : 6 9[06 'S '4nd <br />