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6090 'ON ME :O [ LI0Z S upr auaI paniaaa� <br /> Lain <br /> Inedible Kitchen Grease (IKG) Mani:fest LV <br /> Stockton Roto Rooter Grease & Septic Service <br /> � 3'Z <br /> Date: Z. — -z-!—/6 Time: 5` ( AM PM Man fest#L- o <br /> Business Name- O O j -S S <br /> Job Site Address: Z illlip <br /> Customer Name(print). =K (Signature)• <br /> IKG Authorized Receiving Facility Name/Address (circle dump site for faclity) <br /> City of Lodi-VIIluteslough SPCF <br /> 12751 N. Thornton Rd <br /> Lodi, CA.95242 <br /> (209)333-6749 <br /> Date of XKG Receipt_ Z~z/Ame o£TXG Receipt: JC-> Total XXG Received: <br /> eptic Grease <br /> Receiving Facility Rep.Name(Print (Signature)- <br /> Authorized Transporter. Vehicle ecal Number- <br /> Stock-ton <br /> umber:Stock ton Roto Rooter Driver Name(print): a el, by <br /> 4228 Newton Rd <br /> Stockton,CA 95205 Driver Signature: <br /> ZI 'd Z6c9 'aN WdH :: Z LIH 'S 'upr <br />