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[HO '°N AVU :01 9lH '� 'AON ;Wli paniaDad <br /> Inedible Kitchen Grease (IKG) Manifest <br /> Stockton Roto Rooter Grease & Septic Service <br /> Date: /� �� Tiume: a �� AM/PM Manifest#L- <br /> Business Name: Al r <br /> Job Site Address: /el G( Zip Code: <br /> Custol.er Name(print): (Signature): <br /> 1EKG Authorized Recemng Facility Name/Address (circle dump site for facility) <br /> City of Lodi-VV-Wteslough$WF <br /> 12751 N.Thornton Rd <br /> Lodi, CA 95242 <br /> (209)333-6749 <br /> Date of KKG Receipt Time of IKG Receipt: Total IKG Received: <br /> peptic rease <br /> Receiving Facility Rep.Name(Print) e*lAR's Laf-J6PR-E,' (Signature): e <br /> Authorized Transporter: Vehicle Decal Number: . <br /> Stocl,-ton Roto Rooter Drivel-Name(print): <br /> 4228 Newton 12d <br /> Stockton,CA 95205 Driver Signature: <br /> Z 'd 98 9 'ON AVEl : Ol 9l0Z 'noN <br />