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LZ66 '°N AVS0 :8 S I 0 Z 'A0N zIJJi1 pzniILI 0 <br /> zzzu <br /> Inedible Kitchen Grease (IKG) Manifest <br /> Stockton Roto Rooter Grease & Septic Service <br /> , �� <br /> Date: o ,)� /T" Tune: _ — AIVI Manifest#L- <br /> Business Name: n �Q <br /> Job Site Address:,;�-O(:�6 zip Code: <br /> Customer Name (prin (Signature): <br /> ZKG Authorized Receiving Facility Name/Address (circle dump site for facility) r <br /> City of Lodi-Whiteslough SPCF <br /> 12751 N. Thornton Rd <br /> Lodi, CA 95242 <br /> (209)333-6749 -3 �5 <br /> Q <br /> Date of tKG Receipt: (/'Z� ! 'ime of IKG Receipt: Total TKG Received: <br /> Septic cease <br /> Receiving Facility Rep. Name(print) (Signatu/ree)): <br /> Authorized Transporter: Vehicle Decal Number: ! 7,2Z— <br /> Stockton Roto Rooter Driver Name(print) / /I <br /> 4228 Newton Rd <br /> Stockton,CA 95205 Driver Signature: <br /> 9 'd LzK 'IN WHLE : 9 SIR z "IN <br />