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SpATE of AzTFo1 -0690 "N Wdtiz ° 9 9lOz 'Ol 'ady ;W I i pansy a i� DFFA TMYT OF FOOD AND A.GRICU'TURE ' M a'ouz iy and Egg Saf4iye ch Manifest No.12,-c'6f`3( 1220 N Stress Sact=eato,CA. 95914 - (916)900-5004 79-124 (Est.1.1112) Manifest- Tne&ble Kitcheia Grease Tr-anspor-t Tnstruebbns and Ree t 'Faa�a�lty Information =A complete Inedible Krtc en re s� �G)T1rmaVolrt Max fest for a load of IKG consists of#bis forms I and aU generator copies from AeESTorm 79-125(Mani£'est-Ynedxble Kitchen Grease T rauspor# J Generator irnforrnation)`for generators th$t cdutribwe IKG to ae load- ATternativeiy, the tKG ; transporter may use other forms'that conte aU required inform:.ktion. AR forms in eaeb nian7ifest In-as-t ! -save the same IVfaullest Number. ' 'ar spa ens must keep competed ma gists far.two yeaXs. Manifest Instructions: s� i.The driver of the 1KG transport vehicle is responsible for entering all information on this form and on MPES Form 79- ;l :125, Manifest-Inedible Kitchen Grease Transport; Generator lnfbrmafron,1.exceptfor in the Receiving FacTsty Representative and Generator kepresentative name and signature boxes_ All entries must be in ink and legibly The ` driver must initial any caorrections.to Wormation already entered; 1' 2. Enter all information in the form below for each load of lKG_ Give one copy of the completed form to the receiving faciIlty atthe time of IKG reoeipfi or mail or d-liverthe copy to1he receiving facTi ywithin-16-work_days- i 3_ Enter the Manifest Nomber found at the top bf this form in the Manifest No.box_on the generator form(MPES Form 79- 125)for each generator-that contributes to th ,ioad_ All generator-formsfrom generators when:KG was collected to f make up the load must have the same Manifest Number as the attached Receiving PacilltY Information form. 4. Give the generator copy(from MPES Form 79-125)to the generator atthe time of lKG collection or mail or deliver the copy[to the generator within 4Z calendar days. _ 5_Attach the generator forms (MPES Form 79-125)for all generat6rs-that contributed to the load of IKG to this-Form. Maintain this form and the attached generator forms for two years from the date on this form. D3f�of rfGG Receipt Tune of 11CG Receipt Used Cooking 4a ; TY pe of IKG_ .:i interespfor/Trap Gn.,as� �� Name`. Receiving FaalityRddr :U,�-." y Total 1KG Received: Measuring Method Used- GoritainerVoluMe'(if Required); Ferc*ntage Fig ofRequirEd). atlons 3 Rcc_SjF,tered Tran--porter Name= V6hicte/Dee+ca/l]Number_ - II Driver N3rne(Frinfe = RBa6Mng roc sty pPprasantative Name(Pnrrted)' 11 4` Ln36PRE I DReca ng ility river s2ativeSignafrrre l WdLz :9 9�0z add