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6$50 'IN wW uj11 paA ;d <br /> Inedible Mtche.n Grease (I G) Manifest <br /> StOckton Roto Rooter Grease & Septic Service � Ls <br /> Date: 4�Z & Time: r, A-N-41D Manifest 9 L-)j ri <br /> Business Name: J <br /> ,fob Site Address: v. 6k Zip C e: " <br /> Customer Nance(print): � (Signature): <br /> IXG Authorized Receiving Facifity Name/Address (circle dump site for facility) <br /> City of Lodi- ateslougia St�6F O'R C, <br /> 12751 N. Thornton Rd <br /> Lodi, CA 95242 <br /> (209)333-6749 <br /> Date of 1KG Receipt: / Time of IKG Receipt: Total 1KG Received: <br /> Septic s� <br /> Receiving Facility step_Name(Print) t7` (Signature): <br /> Authorized Transporter: Vehicle Decal Number: 77--!ZA�7 <br /> Stockton Roto hooter Driver Name(print): } <br /> 4223 Newton Rd <br /> Stockton,CA 95205 Driver Signature: --- <br /> d 19 'ON AV60 $ 910 'S l 'a 2W <br />