ARCHIVED REPORTS_PUMP RPTS 2014 - Laserfiche WebLink

Home Browse Search

L1E9 "N AdN :9 tiI0 0 'Unr a.uil paAiaaa'd STATE OF CAUFORNU 9 AEFARTMFNT T-OF FOOD ANA AGRICULTURE � Meat,Poultry and Egg Safety Branch - -.,., Manifest No.. OM 1220 N Street ; Sacramento, 95814 (916)900-500404 r ,{ 79-124 (Est-11/12) L Manifest - Inei ni--W it chen G cease Transport L_ p� ' facility Information �J Instructions and Receiv�ing tY A complete Inedible Kitchen GreaseG)Transport Manifest for a load of IKG consists of this form and all generator copies from MPES,Folrnn 79-125 (Manifest-Inedible Kitchen Grease Transport, Generator Information) for generators that cohtribiite IKG to the load. Alterna*ely,.the IKG transporter may use other forms that contain all required information. All forms in each manifest must ; l have the same Manifest Number, Transporters must keep completed manifests for two years_ Manifest Instructions: 1. The driver of the IKG transport vehicle isresponsible for entering all information on this form and on MPES Form 79- 125, Manifest-Inedible Kitchen Grease`transport, Generator Information, except for in the Receiving Facility d signatrlre boxes. All entries must be in ink and legible. The Representative and Generator Representative name an driver must initial any corrections to Information already entered. 2. Enter all information in the form below for each load of IKG. Give one copy of the completed form to the receiving facility at the time of IKG receipt or mail or deliver the copy to the receiving facility within-15 work days. 1 3. Enter the Manifest Number found at the top.'Af this form in the Manifest No. box,on the generator form (MPES Form 79- a 125)for each generator that contributes to the load. All generatoforms from generators where IKG was collected to make up the load must have the same Manifest Number as thea.ttached Receiving Facility Information form_ 4. Give the generator copy (from MPES Form 79-125)to the generator at the time of IKG collection or mail or deliver the copy to the generator within 45 calendar days. 5. Attach the generator forms(MPES Form 79-125)for all generators that contributed to the load of IKG to this form- : l Maintain this form and the attached generator forms for two years from the date on this form. rReceiving or NCG eoeipt Time Qf IKGReceiptTypeofUsed Cooking Oil /0-2PM IKG: IntssceptorlTrap Grease Facility Name: 0 Receiving Facility Address_ otal IKG Received' Measuring Mathod Used`. container volume(if Required): tge Fill(If rtequired): Gallons f �6 7 Q Pounds / ' GtJ 1 vehicie I Number. Registered Transporter Nerve: �S e DReceiving Fadi'rry Regn�entative Name(Printed): river Name(Punted): Driver Slgnab c Receivi acility Representative Signature: 0T/90 39"d �:Gioo�1 0101 9Z6SS9b6K 90 :LT VTK/OT/90