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9SWIN Wd6S :0l 9[62­ 'A� A ;Wli P;Al ;);� <br /> _ Inedible Kitchen Grease (IKG) Manifest <br /> Stockton Roto Rooter Grease & Septic Service <br /> Date: Time: "X,.L_3AM(2m Maiaifest#L- <br /> Business Name: I ra,` r, <br /> Job Site Address ? `7 ' , _--- '��� Zip Code✓' ', ' <br /> Customer Name(print): f,,�;,�/`,✓r i: .».( 'mature : <br /> 1XG Authorized Receiving Facility Dame/address (circle dump site for,facility) <br /> City of Lodi-Whiteslough SFCF <br /> 12751 N. Thornton Rd <br /> Lodi, CA 95242 <br /> (209)333-6749 <br /> hate of lKG Receipt: �^3(!�-1T me of lKG Receipt/:4 rZ-S'�) Total ZKG Received: J <br /> f \ <br /> Septic :µ Grease 11 <br /> rr �� <br /> Re.ceivinn Facility Rep.Name(Print) <br /> Authorized Transporter: Vehicle Decal Number. <br /> Stockton Roto Rooter Driver Name(print)- <br /> 4228 Newton Rd _ - <br /> Stockton,CA 95205 Driver Signature, <br /> Z l 'd ti80 'ON WdtiO : l L 9106 '8 ��W <br />