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STA-MOF CALZrOM1% 6850 'ON Wd90 8 9102 Sl 'a �W quail pania3;� - <br /> DEPARTNENTW FOOD A"AGRICULTt7RE <br /> Meat,Poultry and Sa#etyBrguch ; <br /> 7220 N Street <br /> Manifest Ncr; � t <br /> Sacramento,CA 95,314 <br /> (916)900-5004 <br /> 79-124 (F-sc 1IYI2) a <br /> Na•nifest T.edible Kitchen Grease '�'r•aris�ar� <br /> Ins&uctiOns and Ree " i •T'acflity Information <br /> 'A complete IneMle Mt& grease PIM)Transport M= fest for a load of WG coutL- s of ffib folrat � <br /> and an generator copies from PAPES�For n 79-125(Nfauffest-Ined7ble Kitchen Grease Trw sport, f <br /> Generator T iforniation)•for gerierntors that c8htribAfe IIKG to:the load. A.ltematxv ely,the 10KG } <br /> transporter may use otlxex forms that contain.all requiored on. All forms In each manffest must <br /> 'have the same ' A Iha XV'umbear_ �'rauspr3rtexs'mtyst keep eompleted-im' ri ests-for.two years. ! <br /> M allNest Instructions. <br /> 1.The driver of the IKG transport vehicle is responsible for entering all inforrna ion on this form and on MPES Form 79- <br /> :125, <br /> 9-:'125, Manliest-Inedible 1Gtehen Grease Transport Generator Info orr,'.ex=pt for in the Receiving Facirty <br /> Representative and Generator Representative name and signaWre boxes- All entries must be:in ink and legible_ The I� <br /> driver most initial any conscUons.to information already enttemd; <br /> 2- Enter all information in the form below for each load of IKG_ Give orle copy of the completed form to the receiving <br /> fact ri�y atihe time of 1KG rec6ipt or mail or deiiverthe copy"s receWmg faclRywithin-15 workdays_ I <br /> I <br /> 3. Enter the Man'rTrest Number found @: 'tbe fop Qf this form irr ti re Manifest No. box.-n the generator form(MPES Form 79- <br /> 1255)for each generator that rontrthutes to ths.load. All generator forms from generators where IKG was collecl:ed to <br /> make up the lead must have the same Manifest Number as the attached Receiving Facility Information form, <br /> 4.Give the generator copy(from MPES Form 79-125)to the generator at the time of lKG collection or mail or deliver the <br /> copy to the generator within 45 calendar days. _ } <br /> b.Attach the generator fomts(MPES Form 79-125)fbr all generators that contributkW to the load of IKG to this forn-L }� <br /> Maintain this form and the arched denprrator forms for two years from the date on this form. pl <br /> 1 <br /> Date of MG Receipt Trne of[KG Racaipt L] Used Cook5i_g Oil ! <br /> / <br /> AM IKG: ( <br /> . � ,P'S� trtan:aptan'rrap Grease <br /> `�� <br /> R&n:5�Mng Facoly 3rrin', <br /> _mg.Faa - ... <br /> FteceivTtyAdd :"" <br /> T=11KG Received: Measuring Method Used: ContainerVorume F equired): Perranbge Fill Of Required): <br /> Ltlans <br /> Pounds dao <br /> Registnrect TransMrtar Name. Vehicle deur Nurnber <br /> DrNer Name(P6nft4' Rec6iAng Facility Rapmse Nacre(PFh7ted): 3' <br /> DriverSigrr26ur� � Receivin 1=aot7dy I�Rrr�ve Si9n�#ur�:' �i <br /> I� <br /> jr <br /> 'd S l 'aN 0601 M6 'S l 'a PW <br />