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0 a ;UJ1 aA1 0 s-�.-rEOFCAMO 19 0 ' gab 9 OZ_ '6 q �_ 1 P n DEPARTWNT OF FOOD AND AGMCUMTE Meat,Povluyard Safety Branch . Manifest NO:: 1220 N Street Sacrz==to,CA 95814 (916)900-5004 _ r 79-124 (Est 11112) Mantifv,st-Inedible Kitchen Grease Tr-aiasport , instlru dons and Rec4ving.F2iCi�iity' Information r w i �A complete ZneMle,Kitchen,,��e;�'.se ��'ransport Manifest for a load of IKG coz�siists of this farm ;and aU generator copies from A PES-Form 79-125(l fest-Inedible Kitchen Grease Dksnsport, Generator ormadon)for generators that cdntribtite IKG to'the'load. A llternat eiy,the II G transporter Way use other forms that contain.aR required informat On- AIl forms in each fest Ernst -have the same Msnifest Number. Transporters.must keep completed-mlattivifests fortwo years- Manifest Instructions: s� 1.The driver of the IKG transport vehicle is responsible for entering all information on this form and an MPES Faint 79- ;12�a, Manifest-Inedible K,tehen Gre2se Trarlspariy Generator lnfomiation,'-excep for in the RecehAng FacTrty Representative and Generator Representative name and sighatUre boxes. All entries must be in ink and legible_ The rl driver must irirtial any correctionsto information already entered. i 2. Enter all information in the form below for each load of IKG- Give one oppy of the completed form to the receiving - -facility attt-he time of IKG recNpt or mail or defirerthe copy tote remNing facility within-15work.days: ,3,Enter the Manifest Number found at the top bf this form in the Manifest No. box.on the generator form (MPES Form 79- :1.25)for each generator that contributes to the,ioad. All geneTtz forrns,from generators where IKG was collected to make rep the load must have the same Manifest Number as the attached Receiving Facility Information fnrrn. } 4. Give the generator copy(from MPES Form 79-125)to the generator at the time of lKG collection or mail or deliver the 1 copy to the generator y ttyin 45 calendar days. _ 5.Attach the generator forms(MPF-8 Form 7'9.125)for all generators that.contributed to the load of IKG to this farm_ j Maintain this form and the attached generator forms for two years from the date on this farm. � .r of IKG Recei�� Time of IKG Receipt: T of Q Used Cooking Oil Data s 1 ; ; Type � IKG: , lntereeptor/Tszp Grease P,r�i+nr4q>=ar�Cztyr Name= ,. i Receiving FacaTV Addrv�.-° ff 7 10 Total IKG Received: Me25UriRg Method used: corrtainervolurne'(rf Required): Percentage Fig(tf Required): allons 'd � r/r� f,, L j Pounds ( Registered Transporter Name VQhicie oar Nvmbe� _ driver Naive(Prirrted}: ivim Facility Representafive N3ma(Printed)- . . ' pmrerSignature: Receiving Fa Represerrta Si a T S 'd 09D '°N WdNZ E 9102 b gad