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L690 'ON WdtiZ : 9 9 l 0 Z 'El 'adV ;UJIi P;AI ;0a� <br /> v <br /> 4 1 Inedible Kitchen Grease (IKG) Manifest <br /> Stock-ton Roto Rooter Grease & Septic Servieee LIP b 117 <br /> Date; Z l - Time: -� AM! l�Zamzfsst#]L- <br /> Business Name: f ed '5"' <br /> .lob Site Address; ��-�t� l.�, ������rr�.•--� L� G�- 'dip Code: ��` <br /> (print): L,��CvrA tie( (S�ignature)CCustomer NameA�'ni) � <br /> i<G Authorized Receiving Facility Name/Address (circle dump site for facility) <br /> City of Lodi-tiVhiteslough SPCF <br /> 12751 N-Thornton Rd <br /> Lodi, CA 95242 <br /> (209)333-6749 <br /> Fate of IKG Receipt_ / / 'T'ime of IKG Receipt: 'Total IKG Received: <br /> Septic <br /> Receiving Facility Rep.Name(Print) 176a ignature): <br /> Authorized Transporter- Vehicle Decal Number: 'VAC �1 <br /> Stockton Roto Rooter Driver Name(print) <br /> StocNewton Rd b - +� <br /> Stockton,CA 95205 Driver Signature"' <br /> 9 'd 662ti '°N NG6 ;9 910 l 'add <br />