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�9SC0 'IN Wd6S :01 9 [H ��W quail pania�a� <br /> ST--=1F_of C,ALIFoRIIIA - — - - -- - <br /> PKPARfiIVIE W OF FOOD AND AGRZ'CULTMa <br /> &Ie4 Poultryand Egg Safety Branch <br /> 1270 rt straer Manifest Nct,-. � <br /> sacrame�ato,CA 95814 � <br /> (916)900-500 _ <br /> 79-124 (Est II/I2) <br /> �} <br /> Maxt est- lued ilble Kitchens Grease Transport f f i <br /> InArac -fions and Receivir-�aeTty Informationf U � <br /> :A complete Inedi--ble Mtchengeese )Transport Manifest for a load of IKG consists of#his form I <br /> ,and all generator copies froaat;f WES For-i 79-I25[Manfest-Inedible Kitchen Grease Transport, <br /> Generator Worniationy for generators'thst-t�ftbibrite IKG t&the-loach Alterna t>Evely,the IICG <br /> transporter-nay we other forms that contain all required in9rormaUon. AR forms in.each moariifest must i <br /> 'have the same Man:kiest NtYm-her_ Transpoiiers'must keep completed•max6fests fox'-two years. � <br /> t <br /> Mariffest Instructions: <br /> s <br /> 1,The driver of the IKG transportvehiole is responsible-For entering all information on this form and on MPES Form 79- <br /> :125, Manifest-Inedible Kitchen Grease Transport, Generator lnfbi a* on,'_exceptfbr in the Receiving Facility R <br /> Representative and Generator Representairve name and signature boxes. All entries must be in ink and legible_ The !3 <br /> driver must initial any corrections.to information already entered; r� <br /> 2. Enter all information-in the form below for each load of IKG. Give one copy of the completed form to the receiving <br /> 'favi rty at thetimeof IKG receipt or mail or deliver the copy to the recaiving facilitywithin-15�workdays_ �. <br /> I <br /> 3. Enter the Manifest Number found at the top Af this form in the Manifest No.box_on the generator form(MPES Form 79-• t <br /> 925)for each generator that cvrit7ibutes to th.load. All generator forms front generators where IKG was collected to } <br /> make up the lead must have the same Manifest Number as the attached Receiving Faoil"rty Information form- <br /> 4. Give the generator copy(from MPES Form 79-925)to the generator atthe time of IKG collection or mail or deliver the <br /> copy to the generatol-:within 46 calendar days_ _ <br /> 5_Attach the generatorforms(MPES Fonn 79-125)for all generators that,contributed to the load of IKG to this form. � <br /> Maintain this form and the attached generator forms for two years from the date on this form. <br /> life of lKG Receipt Ttme ar 1FiG FteG:3i ; Type of Q Used Cooking off <br /> f <br /> if <br /> 11CG- <br /> �r glyl PM fLj jInten�gtorlrrap Gre~se f <br /> RG-Celvarg FaaTrty Nome: i. <br /> Receiving 3�dlityAdd�Ss~"""" \ �� <br /> Tatz,l IKG Received. Measuring Nieffiod Used Container Volume-Of Required). Percentage Fiat(if Requu d)- <br /> Q Gallons ,� <br /> El Pounds' <br /> Re_gL5t-_rnd Trans-porter Names Vehicle Decal Number_ <br /> - t <br /> Driver N2me(prirhed)- Rac6mng Facility Representative Noma(Prurteci): <br /> VIS <br /> �Y�V � V4•l�u L <br /> Driver Signgh tre_ w 7 -ins�drrty Representative Signature:' ! <br /> I <br /> -� <br /> z d ti86� �N WdZO : II 9lH 8 ��W <br />