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1HO '°N AVU :U 91H- -E 'noN ;Wli Pani ;); <br /> Inedible Kitchen Grease (XKG) .Manifest <br /> Stockton Roto Rooter Grease & Septic Service <br /> Date: 10)1-7 Ja Time: a �Alq/,ff Manifest#L- 2-3 <br /> Business Name: <br /> Job Site Address: `-4-1 VA- Zip Code: <br /> Customer Name(print): f (Signature). <br /> 1KG Authorized Receiving Facility Name/Address (circle dump site for facility) <br /> City of Lodi-Whiteslough SPCF <br /> 12751 N.Thornton Rd <br /> Lodi, CA 95242 <br /> (209)333-6749 <br /> Date of[KG Receipt: le ime of IKG Receipt: X Total IKG Received: <br /> eptxc Grease <br /> Receiving Facility Rep.Name.(Print)S;!S6(V-C%�-ta(L"Signature . <br /> Authorized Transporter: Vehicle Decal Number: rim. 711 q 1 <br /> Stockton Roto Rooter Driver Name(print): a L h A_S d/N" <br /> 4228 Newton Rd <br /> Stockton,CA 95205 Driver Signature: <br /> z I 'd 9H9 'ON AVtiZ : O l 9l0Z '^ON <br />