Laserfiche WebLink
r ) C690 'ON Nd�� : 9 9102 '� 1 'Idy awil pania)ad <br /> Inedible K'%tchen Grease (IKG) Manifest ,. <br /> Stockton Roto Rooter Grease & Septic Sex-vice <br /> Date: Time: a PM Manifest#L- <br /> Business Name: 2 <br /> Job Site Address: �Fr� ZYp Cade: <br /> Customer Name (print): (Signature): <br /> II G Authorized Receiving Facility Name/Address (circle dump site for facility) <br /> City of Lodi-W itesloug11+4116f <br /> 12731 N.Thoraaton-Rd <br /> Lodi, CA 952=12 <br /> (209)333-61749 <br /> Date of IKG Receipt: Time of IKG Receipt: Total iKG Received: <br /> Septic cease � <br /> Brt <br /> Receiving Facility Rep,Name(print) 6A)6posignature)-� <br /> e n <br /> Authorized Transporter: Vehicle Decal Number: 1 <br /> Stockton Roto Rooter Driver Name(print): , <br /> 4228 Newton Rd / <br /> Stockton,CA 95205 Driver Signature.- <br /> 'd <br /> ignature:'d HS '°N NdH :9 9102 l 'ady <br />