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HWIN WdH S 9l06 Zl 'aa0 ;W11 paniaaad <br /> Inedible Kitchen Grease (IKG) Manifest <br /> Stockton Roto Rooter Grease & Septic Service <br /> Date: I ?- /6 Time:, 2_;z-S� A1V1 PIvX Manifest#L- Q2,� <br /> qY' <br /> F <br /> Business Name: p p AC - A W Es F <br /> Job Site Address_, "7-2 8 ���J� Q Zip Code: 7 ' �2 <br /> Customer Name (print): / ,tJ("4j gf Gp(Signature): <br /> 1KG Authorized Receiving Facility Name/Address (circle dump site for facility) <br /> City of Lodi Whiteslough SPCF <br /> 12751 N. Thomton Rd <br /> Lodi, CA 95242 <br /> (209)333-6749 <br /> -1 15-3 �� 0 00. <br /> Date of IKG Receipt Ll ��e f XKG Receipt: Total IKG Received: 6 r�llo�n <br /> Septic grease <br /> Receiving Facility Rep.Name(Print)�r �{`Gt I-l�°G'fy� Sig[tatu �`�� <br /> _ la <br /> Authorized Transporter: 'Vehicle Decal Number: 7 L� <br /> Stockton Roto Rooter Driver Name(print): <br /> 4228 Newton Rd <br /> Stockton,CA 95205 Driver Signature: <br /> 'd 1299 'ON &H : s 91H 'Zl 'aa0 <br />