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HSO 'ON NV90 .9 910 �� '�pW au�il Paniaaa� <br /> Inedible Kitchen Grease (IXG) Manifest � <br /> Stock-ton Roto Rooter Grease &. Septic Service. <br /> WWI <br /> Date: �rlD Time: r; AM I PM Manifest#'L 0 <br /> 4 <br /> Business Name: <br /> Job Site Address. ; - Zip Code: �l <br /> Customer Name (pr int}. G1`�tl '}' ' (Signature): <br /> :?. . <br /> 1'G Authorized Receiving Facility Name/Address (circle du p site four facility) <br /> City of Lodi-Whiteslounh SPCF <br /> 12751. N. Thornton Rd <br /> Lodi, CA 95242 <br /> (209)333-6749 <br /> Date of 7TCG Receipt: Time of rKG Receipt: /iotai IIiG Receive({: 1 GQ <br /> Qepti Grease <br /> Receiving Facility Rep.Name(Print) "[ 4 signature): <br /> Autborized Transporter: Vebicie Decal Number; <br /> Stockton Uoto Rooter Drives Name rant . 12a.nAV --3—r6\ Cly <br /> 4228 Newton Rd <br /> Stockton,CA 95205 Driver Signature: CkL <br /> 0 <br /> 9 'd S l 'ON wd60 1 9 l '�l 'a pw <br />