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L1E9 "N M0 : 9 0 -0l -unr emit paAiau'a� STATE OF CALIFORNIA CULTURE 7 ' NT OF f OOD Aim AGRX 3 DEpAR Meat,Poultry and Egg oferyBranch .. �. , _.__ .�. . . , •- ,,: Manifest No.: RQ_p o 9p 1220 N Street z I Sacramento,CA 95814 1 1 { 1I (91.6)900-5004 � � 3 79-124 (Est 11/17) I . __.._�._�.., . �y,. .� ��,• Manifest - Inedible Kitchen Grease Transport r � Instructions and Receiving Facility Information A complete Inedible KitchOn Grease(EKG Transport Manifest for a load of IKG consists of this form and aU generator copies from MPES°Form 79-125 (Manifest-Inedible Kitchen Grease'Trattsp6rt, Generator Information)for generators that contribute!KG to the load Alternatively, the 1 KG Generator may use other forms that contain 211 required information. All forms in each manifest must leted imani9(ests'fol<two years_ 'have'the same Manifest Number. Transporters must keep com p Manifest Instructions: 1_ The driver of the IKG transport vehicle is responsible ee r ante ator I information for in on Ithe Receiving Facs form and on ility Form 79- :I 125, Manifest-Inedible Kitchen Grease Transport, Representative and Generator Representative name and signature boxes. All entries must be In ink and legible. The 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 mall or deliver the copy to the receiving facility within-15 work days. 9 J e to .of this form in the Manifest No.box.on the generator form (MPES Form 79- 3_ Enter the Manifest Number found at tti topof 125)for each generator that contributes to the load_ All genel'ator forms from generators where IKG was collected to make up the load must have the same Manifest Number as the attached Receiving Facility Information form. ` 125)to the generator at the time of IKG collection or mail or deliver the 4. Give the generator copy(from MPES Form 79 y, copy to the generator within 45 calendar days. 5. Attach the generator forms(MPES Form 79-125)for all generators thatcontributed to dthis the load this form and the attached generatooad of IKG to this form. r forms For two Y from thea ri o Time of IKG Receipt. Type of Used Cooking Oil DatE of HCG Receipt C./ PM IKG: IntermptortTrap Grease Race ng Fa 'RY Name: Receiving Facility Address: Container Volume(if Required): Percentage rill(If Required): Total IKG Received: Measuring Method Used: G Galbns � � . � Pounds Vehicle pal Number. Regi red Transporter Name: IReceiving Facility Rapresesrtativa Name(Printed)' prSver Name(Printed): /� S presentative Signature: Recti' acil'i1y Repress >9 pmrer Signature: GST/be 39Vd ;J=0Z1 010 1 9Z65S9ti6aZ 90:LT PT9Z/9T/99