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0960 `oN WdH :: 9 [0Z '�[ '� nr ;inti paniaa;� <br /> Inedible Kitchen Grease (IKG) Manifest <br /> Stockton Roto Rooter Grease & Septic Service <br /> Date: _ �2C- l Time: 2-6 NI/PM Manifest#L- c2 o 3 <br /> Business Name: po r /A <br /> Lcc�L� <br /> Job Site Address: 0 Gl-lo o 5 Zi Code: <br /> Customer Name (print)Z"" �a�e�.��Signature): <br /> T1£C Authorized Receiving Facility Name/Address (circle damp site for facility) <br /> City of Lodi-Whiteslough SPCF <br /> 12751 N. Thornton Rd <br /> Lodi, CA 95242 <br /> (209)333-6749 <br /> Date of XKG Receipt: [etime of YKG Receipt: 1' Total IKG Received:` 74�4-" <br /> Septi< Grease <br /> Receiving Facility Rep.Name(Print) U-f" LotjG)°/��(Signature): / <br /> Authorized Transporter: Vehicle Decal Number: <br /> Stockton Roto Rooter Driver Name(print): ev"jl/ <br /> 4228 Newton Rd , <br /> Stockton,CA 95205 Driver Signature: <br /> 9 'd 9295 '°N Wd�� :ti 9l0Z lnr . <br />