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6050 "N 090 :0 9106 1 p9AIaaa� <br /> -41 <br /> Inedible Kitchen Grease (IKG) Manifest <br /> Stockton Rota Rooter Grease & Septic Service <br /> v. <br /> Date: - Time: ANOPM l�Tanifcst# L <br /> Bustuess Name: <br /> ,lob Site Address: r E ! �- :- t �* Zip Code: alz <br /> Customer Nanne (print): <br /> JOKG Authorized Receiving Facility Name/.Address (circle dump site for facility) <br /> City of Lodi-Whiteslough SPCF <br /> 12751 N. Thornton ltd <br /> Lodi, CA 95242 <br /> (209) 333-6749 <br /> Date of IKG Receipt;�'�t�-'_t_��Time or[KC Receipt: 0. Total IKG Received: <br /> Septic Grease <br /> Receiving Facility Rep.Name(Print) (Signature): / <br /> Authorized 'T'ranspor'ter: Vehicle Decal Ntixub, � <br /> Stocktpr� 92c�to Rooter. Driver Naxae(print): <br /> 4228 Newton Rd / <br /> Stockton,CA 95203 Driver Signature: <br /> r✓/ <br /> 5 d 519tr 'ON AV60 :0 910 1�1 IAVH <br />