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L960 '°N WdH:: 9101 'El Ili panizDad STATE OF C AMA DD _..,7lFN-T OF FOOD AND AGRICULTURE z 0 x L:r and'Egg suety 1 _ '_ . Manifest No:: Sacr�euco�CA 9$,314 I (916)9004004 -• 79-124 (Est i v=) Manifest-- Yn.edi-ble Mtehen Grease Trazisp' ort Instruedt)ns and Recdving•Faei W Informa-don. CJ 'A,evmpllete IhedYble Krtrheri ease L G)TrauVort Man els for a load o ASG cohs�sts of this form ..and aR generator copies from MPESTo rm.79-125 (Manifest-,Inedible Mtchen Grease Transport, 1 Generator Worniation)-for geiierators-&-at cdntribate IKG td'the•ioad- Alternatively,the IKG ' trs-auVoxteir may use other forms that contain aR required mforma_tiion. An forms m each manifest must -have the Isom'e' 11�est Niamber. Transpoi lexs'mnst keep conapl ted-faariffests fOr.t'WO yeas. itManifest Instructions: 1.The drl{uer of the IKG transport vehicle is responsible for entering all lnformabon on this-Form and on MPES Form 79-- -125, Man7est-InedRAe,I<Achen Grease Tpansport Generator Infbnma5 n,:-except for in the Receiving Fadlfr�j Represel1ta$ie and Generator Representative name and signature bones_ /all entries must be In Ink and legible. The driver mulit initial any corrections,to information already entered. 2.Enter III information in the form below for each load of IKG. Give one copy of the completed form to,the receiving f foci rRy at the time of IKG receipt or mail or deliver the copy to-the rer*wing facility within-15•work.days.' -I :3. Enter the Manifest Number found atthe top Qf this form in the Manifest No.box°on the generator form (MPES Form 79•- 125)for eaoh generator that contributes to ttte.load. All generator forms froge9erators where IKG was collected to make up thq load must have the same Manifebt Number as the sitaehedm Receiving FaciRy Information form. 4. Give the generator copy(from MPES Form 79-125)to the generator at the time of IKG collection or mail or deliver the copy to the generator-within 45 calendar days. � S.Attach the genitor forms (MPES Form 7125)for all generators that contributed to the load of IKG to this form. Maintain Is form and the attached genpratorforms fortwo years from the date on this form. Date of 1XIGRer ipt -aims of 1KG Receipt Used Cooking Oil �j� 3' Type of IKG InteresptodTrap Grease g! R6ce7vThg Paa"dty Name: - _ . .tj Re g Faa'lity Addre3e l75 Total!KG Relived- Gallons Measuringstfrisg WletHod Used: Contai er Volume'Of Required)- Percentage Fill Qf Required): Pounds Regist8a TransportnrNamm Vehicle Decal Number- .. i E(- Driver N e(P trrtftd): Ramsi g PaaTrty Repm?senrative Name(Primed): � / l N � driverSignafltre. RecimiQ Far-iw Rep motive siprratura' 1;1 .I 'd 96SS 'IN 9101