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A)5--3 9210 "N AVIO : ll 9102 01 'jD0 ;Wli pani ;D;� <br /> Inedible Kitchen Grease (IKG) Manifest 67VStockton Roto Rooter Grease & Septic Service <br /> Date: / � Time: /PM Manifest 9 L- 0�12115, <br /> Business Name: �oy <br /> Job Site Address: 52-530 Z_/ Lip Code: � Y� <br /> Customer Name (print): 14cVe— (Signa-ture)- <br /> IKG Authorized kteceicvmg Facility Name/Address (circle dump site for facility) <br /> City of Lodi-WhiteslougL CF <br /> 12751 N_Thornton Rd <br /> Lodi, CA 95242 <br /> (209)333-6749 <br /> Date of iKG Receipt:— L/ Time of TKG Receipt: Total IKG Received: <br /> Septic (ire ase <br /> Receiving Facility Rep..Name Print lam. �Sig <br /> nature): <br /> Authorized Transporter: Vehicle Decal Number- <br /> Stock-ton <br /> umberStockton Roto Rooter Driver Name(print): <br /> 4228 Newton lid <br /> Stockton,CA 95205 Driver Signatare: ' <br /> 'd 0619 'ON W1 : 11 9102 01 ';�o <br />