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9SL0 "Nf Wd651[ 9M 'E 'Aq awil paAI ;3;� <br /> -LLL/ <br /> Inedible Kiteben Grease (YKG) Manifest <br /> Stockton Roto Rooter Grease & Septic ServiceL— An i T4 <br /> Date.- -4 <br /> : ' 101 0 Time: � — AM!FM Manifest#L- 0 r�,c'(�-�. <br /> r <br /> Business Namer <br /> Job Site Address: �� ��e' �c;.� dip Code:� l�> <br /> Ini <br /> Customer Name (print): [4/A 1 <br /> IKG Authorized Receiving Facility Name/Address (circle dump site for facility), <br /> City of Lodi-'W�iteslough SPCF <br /> 12751 N.Thornton Rd <br /> Lodi, CA 95242 <br /> (209)333-6749 <br /> i <br /> 02te of I KC Receipt: of I1W Receipt: Total IXG Received: �4 _ <br /> Septic Grease <br /> Receiving Facility Rep.Name(Print)%!:,(-�d��',���r (Sxgz�ature} ." �' ?;'. . " <br /> y u' <br /> Authorized Transporter: 'Vehicle Decal Number: <br /> Stockton Roto Rooter Driver 1+Iacrie(print):'-� ` 'a. cam:,. l :v <br /> 4228 Newton Rd \ r <br /> Stockton,CA.95205 Driver Signature:,)- <br /> 01 'd tr26ti 'ON NVH : L l 9lH 'E .RPW <br />