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9M "N WHLO : II 91H '0l ';�0 @W11 pania);� <br /> Inedible Kitchen Grease (1KG) Manifest LwazilStockton Roto Rooter Grease & Septic Service <br /> Date: / Time: M Manuifest#L-D�l <br /> Business Name: L(, i116L Cei,1//&�e <br /> Job Site Address: e4b S. YKwt LO Zip Code: <br /> Customer Name(print): MeUc-U C • (Sivatuure): <br /> 1KG Authorized Receiving Facility Name/Address (circle dump site for facility) <br /> City of Lodi-Whiteslough$MCF <br /> 12751 N.Thoratou Rd <br /> Lodi, CA 95242 <br /> (209)333-6749 <br /> Date of(KG Receipt: Time of 1KG Receipt: 1 , 1 S Total MG Recelved: /, Vo <br /> Septic Grease <br /> Receiving Facility Rep.Name(Print er AC (Signature): <br /> Authorized Transporter: Vehicle Decal Number: TkzS <br /> Stockton Roto Rooter Driver Name(print): <br /> 4228 Newton Rd y <br /> Stockton,CA 95205 Driver Signature: J <br /> 'd 0619 '°N AvZI : l l 9lH '01 ,130 <br />