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9SO 'IN AOS :01 9106 'APA ;WI J pane a�a� <br /> Inedible Kitchen Grease G) Manifest <br /> Stockton Roto Rooter Grease & Septic Sre.rvi.ee L <br /> Date: / <br /> Time: AAI/CM <br /> Business Name: L (A <br /> � � �� � ��°=✓�G/� G!.� <br /> Job Site Address: w / ' ' Zip Code: ` <br /> Customer Name (priest): (Signature): <br /> 'IKG Authorized Recei-viog Facility Name/Address (circle dump site for facility) <br /> City of Lodi-Whiteslou h SPCF <br /> 12751 N.Thorntom Rd <br /> Lodi, CA 95242 <br /> (209)333-6749 <br /> Date of IKG Receipt: I Time of IKG Receipt: Total IKG Received: —� <br /> Sep ' Grease <br /> Receiving Facility Rep.Name(print)3,QOJL(Signature)-, � <br /> Authorized Transporter: Vehicle Decal Number.- <br /> Stockton <br /> umber:Stockton Roto hooter <br /> giver Name(print): cb <br /> 4228 Newton Rd <br /> Stock ton,CA 95205 Driver,Signatu.re:_., <br /> j �� � '�N <br />