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ti909 "N NdH :E tiI0 '9l 'A PA awil pania); <br /> Inedible Kitchen Grease (IKG) Manifest •�-� <br /> Stockton Roto Rooter Grease & Septic Service <br /> t <br /> Date: —,7// Tim <br /> / e: - . r Manifest#L- 5 <br /> Business Name: t�2.r l =' ` <br /> Job Site Address: . <br /> 2000 (,�� � 1�r,r-vier �. Zip ode: <br /> Customer Name (print): kit t,%_ 1 ,Q� � (Signature): <br /> IKG Authorized Receiving Facility Name/Address (circle dump site for facility) <br /> City of Lodi-Whiteslough SPCA' <br /> 12751 N.Thornton Rd <br /> Lodi,CA 95242 <br /> (209)333-6749 <br /> 3-3 <br /> Date of IKG Receipt: ime of XKG Receipt: Total YKG Received: <br /> Septic Grease <br /> I J <br /> Receiving Facility Rep.Name O?rint) Signature): <br /> Authorized Transporter: Vehicle Decal Number: ! Z4Fd_3- <br /> Stock-ton <br /> Stockton Roto Rooter Driver Name(priut): <br /> 4228 Newtou Rd <br /> Stockton,CA 95205 Driver Signature: <br /> 8T/PT 39Vd N=0Z1 OlON 9Z6559b60Z LZ:bT bT9Z/5T/50 <br />