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9SC0 '�N Wd6S : Ol 9�H �pW ;UJIJ pan i a�ay <br /> `3 LT i ! <br /> - C 4 <br /> Inedible Kitchen Grease (YKG) Manifest <br /> Stockton Roto Rooter Grease & Septic Service <br /> is <br /> Date: `1�" Time: AiNI/PINI Manifest#L- } <br /> Business Name: <br /> Job Site Address: 1 (� - _J5 C'LJ�11�, �1 CJ Zip Coder <br /> Customer Name (print);. (Si nature)', <br /> IRG Authorized Receiving Facility Name/Address (circle dump site for facility) <br /> City of Lodi-Whiteslough SPCF <br /> 12751 N. Thornton Rd <br /> Lodi, CA 95242 <br /> (209)333-6749 <br /> Date of II{G Receipt: / Time of 1KG Receipt: Total IKG Received: <br /> J I <br /> =—Sep�fic <br /> Grease <br /> .Receiving Facility Rep.Name(Print) __ (Signature): l �/ �i <br /> �� ! / Ll' <br /> Authorized Transporter: Vehicle Decal Number: <br /> Stock-ton Roto hooter Driver Name(print): <br /> 4228 Newton Rd <br /> Stockton,CA 95205 Driver Signature: C /1 <br /> S 'd tib 'ON Wd�O ll 9lOZ ��W <br />