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LZ66 'oN4VS� 8SIOZ Z ��N a'�!1 paniaa� C <br /> Inedible Kitchen Grease (IKG) Manifest <br /> Stockton Roto Rooter Grease & Septic Service <br /> Date: Time: I'/W�/pM Manifest#L- (,')14E <br /> � <br /> Business Name: /;'YI <br /> Job Site Address: /7/ �7[,t , � , Zip Code: S2 <br /> I <br /> Customer Name (prinE -. (Signature): <br /> IKG Authorized Receiving Facility Name/Address (circle dump site for facility) <br /> City of Lodi-Whiteslough SPCF <br /> 7.2751 N. Thornton Rd <br /> Lodi, CA 95242 <br /> (209) 333-6749 <br /> Date of MG Receipt: /—, ime of IKG Receipt: Total IKG Received: 1,;26n <br /> Septic jrfease <br /> q� 11 __ <br /> Receiving Facility Rep.Name(Print) v,kjA� Lo s4 G Ply (Signature): <br /> Authorized Transporter: Vehicle Decal Number.- ZZ <br /> Stockton Roto Rooter Driver Name(print): QS�U� <br /> 4228 Newton Rd <br /> Stockton,CA 95205 Driver Signature: <br /> 8 'd LZ98 '°N WbLB I S l OZ Z 'noN <br />