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W9 '°N WdH :E tiI0 'SA quail paniaaad . <br /> Inedible Kitchen Grease (IKG) Manifest <br /> Stockton Roto Rootear Grease & Septic Semice <br /> Date: / 7 Time. ��� e M Manifest#L <br /> Business Name: <br /> L Job.Site Address-.-3z..' Zip Code• .O ,° <br /> Customer Name(print): G <br /> IKG ,Authorized Receiving Facility Name/Address (circle dump site for facility) <br /> City of Lodi-`Vhiteslough SFCF <br /> 12751 N. Thornton Rd <br /> Lodi,CA 95242 <br /> (209)333-6749 <br /> Date of IKG Receipt: � Time of LKG Receipt: 10: Total IKG Received: <br /> Septic ease <br /> 'i <br /> Receiving Facility Rep. Name(.Print) �— (Signature): <br /> Authorized Transporter: 'Vehicle Decal Number: 7--Z�2!Z -3 <br /> Stockton Roto hooter Driver Name(print): Ka;z Je,# <br /> 4228 Newton Rd <br /> Stockton,CA 95205 Driver Signature: <br /> 8T/90 39Vd �GiooJ 0101 9Z6559b60Z LZ:bT 17TOZ/5T/50 <br />