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60900 "N ,AdH :: [ MI 'S 'ups 11111 pania)ad <br /> 3 4bO <br /> Inedible Kitchen Grease (IKG) Manifest <br /> Stockton Roto Rooter Grease & Septic Service <br /> Date: /;Z--6 -- /6 Time: /Z,2-6 AA(/:PM auifest#L-a2 —6 <br /> Business Name: i b( e a a G <br /> Job Site Address:- -3 '7;:, �p �/� ( Zip Code: <br /> ! <br /> Customer Name (print ir� y (Signatures- <br /> IKG Authorized Receiving Facility Name/Address (circle dump site for facility) <br /> City of Lodi-WWteslough SPC>F' <br /> 12751 N. Thornton Rd <br /> Lodi, CA 95242 <br /> (209)333-6749 <br /> Date of IKG Receipt: d(o/ Time of 1KG Receipt: 1, lyTotal XKG Received- <br /> Septi Grease , <br /> Receiving Facility Rep.Name(Print . (Signature): <br /> Authorized Transporter: 'Vehicle Decal Number: _ <br /> Stockton Roto Rooter Driver Name(print): PCS o4 <br /> �►u-Sa <br /> 4228 Newton Rd <br /> Stockton,CA 95205 Driver Signature: <br /> ti 'd 16L9 'ON WdH :: [ LIH 'S 'uPr <br />