Laserfiche WebLink
9M "N WHLO : 11 9102 '01 '110 111-111 pan i a0a� . <br /> STATF-OF CALIFORNLk <br /> A AXZTIVJ-UN'T VF J"001)AND AGRICVLTVIRE <br /> i <br /> Me4 d Egg Safety B=rh <br /> .12-20 rt street - Manifest No__QZ 6 3�?,D <br /> Sac =a=to,CA, 95514 <br /> (916)900-5004 <br /> r <br /> 79-7.7.4 (Fst I]/I2) � <br /> Manifest- Tnedx�le Kitchan GreasC Transport - <br /> Instructions and Receiving-FacjW Informatioia ! 0 2 1 f <br /> =A complete Ine&-ble Krtchenl—io",e- G.�Tranipoi t Wlalaifest for a load of 1FCG consists of tt&form <br /> ,and all generator copies from 1% E ,,Form 79-125(Manifest-Inedible Hitchen Grease T7ramport, <br /> Generator Informaiaon7 for gener$tors ifiat c6fbt3bnte IRG to'the load_ Alterna�lbeiy,the lKG <br /> transpo7rter nzay use other forms that contain all,requked 7ftforluaation. AR forms in each nmxXi st puust <br /> -have the same T1 auiest Nwnlber. Transpoirters-mIIst keep completed•mariilfests-fek-two years. <br /> Manifest Instructions: <br /> _ _ I <br /> 1.The driver of the IKG transport vehicle is responsible for entering all information on this form and on MPES Form 79- <br /> .125, Marirfe*�-Inedible Kitchen GreaseTFansport, Generator Infvrmaiion,-.exceptfor in the Receiving Factliiy <br /> Represenialiive and Generator Representative name and sigirature boxes_ All entries must be in ink and legible. The t <br /> driver must initial any correcvonato information already enured; <br /> 2_ Enter all iltformation In the farm below for each load of IKG. Give one oppy of the completed form to the receiving <br /> faclllly at the time of IKG recbipt or mail or de1"iver the copy to-the recaivrng facility within-15 work days_ <br /> 3. i=nter the Manifest Number found at the top)3f this form in the Manifest No. b6x.6n the generator form(MPES Form 79- <br /> 125)for each generator that contr2but3es to the load. All generfborforms•from generators where IKG was collected to <br /> makeup the load must have the same Manifest Number as the attached Reeeiviing Facility Information form_ 4 <br /> 4. Give the generator copy(from MPES Form 79--125)to the generator at the time of IKG collection or mail or deliver the <br /> copy to the generator within 45 calendar days. _ <br /> 5_Attach the generator forms(MPES Form 79--125)for all generators that contributed to the load of IKG to this form_ 1 <br /> Maintain this form and the attached deneratorforms for two years from the' date on this form_ 1 <br /> r <br /> Rale of lKGG Receipt Tone of IKO Recaiused Coo"otl <br /> l G ✓ Type atA/ <br /> ' <br /> / v IKG- cE Interceptor[Trap Grease <br /> PM !i <br /> RA Piing Fa Name-, ( _ `Cts 'f <br /> iZecerVmg Fad'Ir�.y Ad _ "" -/ � <br /> Total IKG Reeewnd: Measunng McMod Used: CordairierVolume'(7f Required)_ Parcentage RR(If Requr <br /> d). <br /> c�Gailons �,/ J J <br /> Pounds .� <br /> Registered Transporter Name: Vehicle Decal Number_ _ <br /> Drhw Name(Prirded). R®Csiving Facility PAPresenhalive Name(Prftrb�!d): 3' <br /> I <br /> 2c) Sem r �c+�C-. <br /> Qrfvarsrgrtahurir R g Fac]Tir r RepnassntativeSigngWrL <br /> r <br /> �I <br /> Z 'd 0619 'ON WHZ 1 : l l 9l H '0l ';00 <br />