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L960 'ON WdOE :ti 9l0l IWI J PIAI ;)ad <br /> Inedible Kitchen Grease (IKG) Manifest <br /> Stockton Roto looter Grease & Septic Service <br /> Z ©moo <br /> Date- Time: AllZ OVD1Nlau fest# <br /> Business Name: p �^ <br /> Job Site A,ddress:_ tL) , �ZeJ 1 ey la n 4-s-1 Lo'�; e4t Zip Code: f` i <br /> Customer Name(print)- (Signatare): <br /> EKG Authorized ceivina Facility Name/Address (circle dump site for facility) <br /> City of Lodi-Whiteslough SFCF <br /> 12751 N.Thornton Rd <br /> Lodz, CA 95242 <br /> (209)333-6749 <br /> Date of 1KC eceipt: G�-I �' Time of IKG Receipt: Total 1KG Received. <br /> Septic Grease <br /> G <br /> Receiving Facility Rep.Name, t) Q c6w HUS (Signature)- <br /> Authorized Transporter: Vehicle Decal Number: <br /> Stockton Roto Rooter Driver Name(print): <br /> 4223 Newton Rd <br /> Stockton,CA 95205 Driver Signature. <br /> z 'd 9ZSS 'ON WdZE :ti 9�0z E [ 'Inr <br />