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L1EYON MO :9 tiIH '0 [ 'ung ;Wli 'P;A 'l O;� <br /> Inedible Kitchen Grease (IKG) Manifest <br /> Stockton Roto Rooter Grease & Septic Service <br /> i <br /> Date:, o� �� lime: D-rQ Y aftifest 9 L-00 7 <br /> l T y <br /> BusinessName: " <br /> S <br /> .lob Site Address: Zip Code: <br /> Customer Nam-p (print): �'Stc�`RP (Signature): <br /> �k w c <br /> 1Kq Authorized Receiving Facility dame/Address (circle dump site for acility) <br /> City of Lodi-Whiteslough SPCF <br /> 12751 N.Thornton Rd <br /> Lodi, CA 95242 <br /> (209)333-6749 <br /> Date of lKG Receipt: Time of IX?,Recel 't- '� Total YKv ff�cexved: <br /> Septic rease <br /> Receiving Facility Rep.Name(Prin 4m (Signature): <br /> Authorized Transporter: Vehicle Decal Number, <br /> Stockton Roto Rooter Driver Name(print): "e ( <br /> 4225 Newton Rd <br /> Stockton,CA 95205 Driver Signature: <br /> ' I <br /> I <br /> ' I <br /> i <br /> i <br /> M . <br /> OT/OT dJdd �Giood 0101 H6559b60Z 90 :LT PTK/0T/90 <br />