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1HVON AVE : 191H 'noN aWl j paniaO;� <br /> Inedible Kitchen Grease (IKG) Manifest -�� <br /> Stockton Roto Rooter Grease & Septic Service <br /> 't <br /> - � <br /> Date: Time: � �� AM/P1VI Manifest#L- <br /> Eusbaess Name: � C l () I/ <br /> Job Site Address: /2 Zap Code:4A <br /> Customer Name (peat): / (Signatare): <br /> 1KG Authorized Receiving Facility Name/Address (circle dump site for facility) <br /> City of Lodi-Whiteslough$WF <br /> 12751 N. Thornton]fid <br /> Lodi, CA 95242 <br /> (209)333-6749 <br /> Date of 1KG Receipt; - Time of 1KG Receipt J� Total 1KG Received: r <br /> eptic rease <br /> Receiving Facility Rep.Name(Print) f*-1A-N5 L&IJ6P4,-- (Signature): c <br /> Authorized Transporter: Vehicle Decal Number: �,���2 <br /> Stock-ton Roto Rooter Driver Name(print): <br /> 4.223 Newton Rd <br /> Stockton,CA 95205 Driver Signature: C <br /> 'd 98 9 'ON AVEl :Ol 9 [0Z 'noN <br />