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[HO 'ON AV91 :01 91H '� 'noN awil P;C;)ad <br /> Inedible Kitchen Grease (IKG) Manifest <br /> Stockton Roto footer Grease & Septic Service <br /> Ante: D / Z,'0`-n(AN!!)PMTime: Manifest 9 L-D,1 <br /> Business Name: � r/ �-�,-y-►- <br /> Job Site Address: Z ZZ 5. 64 ( Zip Code: <br /> Customer Name (print): (Sia tatnre)• <br /> AV <br /> JOKG Authorized Receiving Facility Name/Address (circle dump site for facility) <br /> City of Lodi-Whiteslough4fcF <br /> 12751 N.Thornton Rd <br /> Lodi, CA 95242 <br /> (209)333-6749 <br /> Date of IKG Receipt Time of f ICG Receipt: 1-5Total IK(; Received- <br /> Sep 'c Grease <br /> Receiving Facility Rep.Name(Prin �� (Signature): — kK- <br /> Authorized Transporter: Vehicle decal Number. 72k <br /> �Lf <br /> Stockton Roto Rooter Driver Name(print): [�d� L1�1 <br /> 4228 Newton Rd <br /> Stockton,CA 95205 Driver Signature: <br /> L 'd 9H9 'ON AO : U 91H 'A ON <br />