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LIE9 'ON WdZ0 :9 tiI0 '0l 'unr awil p 1 iaua� <br /> Inedible Kitchen Grease (IKG) Manifest <br /> Stockton Roto Rooter Grease & Septic Service <br /> Date. .W/�/ 'lisle_ Manifest#,L-zXZ�2 <br /> .r <br /> i <br /> T <br /> Business Name: <br /> l <br /> dob Site Address: Zi <br /> Customer Name(print): or, H I AoG (Signature): � <br /> i� <br /> IKG Authorized Receivi' n Facility Name/Address (circle dump site for facility) <br /> g ty <br /> City of Lodi-Whiteslough SFCF j <br /> 12751 N.Thornton Rd <br /> Lodi,CA 95242 <br /> (209)333-6749 <br /> Date of lKG Receipt: �l Time of IKG Receipt: Total ICG Received: <br /> Septic rens <br /> Signature): ! <br /> Receiving Facility Rep.Name(Print �' <br /> Authorized Transporter, Vehicle Decal Number: <br /> Stockton Roto Rooter Driver Name(print): O�� <br /> 4228 Newton Rd <br /> Stockton,CA 95205 Driver Signature: -- <br /> F <br /> 1 <br /> I <br /> OT/L0 39dd d=Oa OlOJ 9Z6559b60Z 90:ZT PTOZ/OT/90 <br />