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L1E9 '0N MO :9 ti[OZ 'Ol 'unr ;Wli pa�nia3;� <br /> Inedible Kitchen Grease (IKG) Manifest <br /> Stockton Roto Rooter Grease & Septic Service <br /> iI <br /> Date:,S �y 1 ime: /. �AMej5g)Maliifest#L-4:�TO <br /> Business Name: <br /> Job Site Address: C: l'O " Zi Code: <br /> Customer Name,(print): L)a r i t' 13/��v-(Signalhu <br /> 1KG Authorized Receiving Facility Name/Address (circle dump site for facility) <br /> City of Lodi-VWhiteslough SPCF i <br /> 1275 .N.Thornton Rd <br /> Lodi, CA 95242 <br /> (209)333-6749 <br /> ,1 <br /> t: �� ime of IKG Receipt: Total IKG Received: <br /> Date of IKG Receip -�— <br /> Septic tease <br /> l� - n1�til i nature <br /> Receiving Facility Rep.Name(Print) g ) <br /> , <br /> Authorized Transporter: Vehicle Decal Number: �i� fQ � <br /> Stockton Roto Rooter Driver Nawe(print); - <br /> 4228 Newton Rd <br /> Stockton,CA 95205 Driver Signature: <br /> I <br /> i <br /> I <br /> t <br /> OT/60 39Vd �Gioo�1 0101 9Z6559b60Z 90:LT VTOZ/OT/90 <br />