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-33y <br /> 9210 '°N PLO : [ [ 9102 '01 '110 aril pania�ad <br /> Inedible Kitchens Grease (IKG) Manifest <br /> Stockton Roto Rooter Grease & Septic Service ac <br /> e/ <br /> Date: l Time: '/'r' AM PM Man fest#L-6,5Z/// <br /> 5� <br /> Business Name: <br /> ,Yob Site Address:�S ,_ �.pn( S+ � �o�� �r� Zip Code: � <br /> Customer Name(print): (Signature): <br /> YKG Authorized Receiving Facility Name/Address (circle dump site for facility) <br /> City of Lodi-WhitesloughF <br /> 12751 N. Thornton Rd <br /> Lodi, CA 95242 <br /> (209)333-6749 <br /> Date of IKG Receipt: A. <br /> Time of lKG Receipt: Total TKG Received: <br /> Septic Grease <br /> Receiving Facility Rep. Name(Print) (Signature): <br /> Authorized Transporter: Vehicle Decal Nowber: 7,t Z752z <br /> Stockton Roto Rooter Driver Name(print): t27 Ato / ulU7l'e <br /> 4228 Newton Ltd <br /> Stockton,CA 95205 Driver Signature: _ <br /> r <br /> 9 'd 0619 '°N AVZ 1 : 11 9102 '01 ';�O <br />