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L690 "N WdtiZ : 9 9102 - '� 'ady a.uil paniaa;� <br /> Inedible Kitchen Grease (IKG) Manifest <br /> Stockton Roto Rooter Grease & Septic Service goo , <br /> S <br /> Date: Time: AIMCTW)Manifest#L—C' 3':S, -� <br /> Business Name: <br /> .l'ob Site Address: ,. dip Code:`�1 �[� <br /> Customer Name (print): ������i;�� ��,.. w4'`�� (Signature): <br /> 61, <br /> EKG Authorized Receiving Facility Name/Address (circle dump site for facility) <br /> City of Lodi-Wlaiteslough SPCF <br /> 12751 N. Thornton Rd <br /> Lodi, CA 95242 <br /> (209) 333-6749 <br /> Date of IKG Receipt as -CITimm o;fXKG Receipt* `7 � Total IKG Received: <br /> ti <br /> Septic Grease <br /> Receiving Facility Rep.Name(Prinignature <br /> Authorized Transporter- Vehicle Decal Number_A 3� <br /> Stockton Roto Rooter Driver Narne(print): <br /> 422$Newton Rd — _ <br /> Stockton,CA 95205 Driver Si;nature:�__ <br /> 'd H98 'ON WdH :9 9106 'E i .add <br />