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LIE9 'ON MO :9 tiI0 -0 'un r awIl panIa�a� <br /> Inedible Kitchen Grease (IKG) Manifest <br /> Stockton Roto Rooter Grease & Septic Service <br /> I <br /> Date: . .� /� '1 ime: �� Manifest#L- C)U <br /> n <br /> . I <br /> I <br /> Business Name: 7.4� -P r elk, All <br /> Job Site Address: 72J L o,01Zi Code: S�y� <br /> Customer Namo (print):!��Y. a s � ��� (Signature): <br /> i <br /> IK6 Authorized Receiving Facility Name/Address (circle dump site for facility) <br /> City of Lodi-Whiteslough SPCF i <br /> 12751 N.Thornton Rd <br /> Lodi,CA 95242 <br /> (209)333-6749 <br /> Date of IKG Receipt: Time of 1KG Receipt: 1 <br /> D v Total XXG Received: -f <br /> Septic reas <br /> Receiving Facility Rep,Name x i.. loik(Signature): G <br /> --�J �� 6 <br /> Authorized Transporter: Vehicle Decal Number: <br /> 9 <br /> Stockton Roto Rooter Driver Name(print): <br /> 4228 Newton Rd <br /> Stockton,CA 95205 Driver Signature:,_ - <br /> i <br /> I " • <br /> I <br /> i <br /> " I <br /> I <br /> I <br /> OT/50 39dd d3100J 0101 9Z6559b6OZ 90:LT bTOZ/OT/90 <br />