ARCHIVED REPORTS_PUMP RPTS 2014 - Laserfiche WebLink

Home Browse Search

ti909 'ON. WdE E tiIOZ_ 'SA_awIl paAiaaa� STATE OF CALIFORNIA. EF TMENT'OF FOOD AND AGRICULTURE Meat,Pouitry aDd Egg Safety Branch Manifest No.: rL.rL�'000 1220 N Street Sacramento,CA 95814 r" (916)900-5004 � a ° t 79-124 (Est.11/12) �" i Grease Transport Manifest - Inedible Kitchen . Instructions and Recelvinlg Facill.ity,Information A complete Inedible Kitchen Grease (JKG) Transport Manifest for a load of IKG consists of this form and:all generator copies from 1V>(FES Form.79-125 (Manifest-Inedible..K.itchen Grease Transport,., Generator Information) for generators that contribute 1KG to the load: Altei->Qativgly,the IKG iiia all re wired information. All forms in each manifest must transporter 1may,use other forms that conta q have the game Manifest Number. Transporters must-keep completed manifests for two years Manifest Instructions: 1_The driver of the IKG transport vehicle is responsible for entering all information on this form and on MPES Form 79- 125, Manifest-inedible Kitchen Grease Transport,.Generaforinformation,except for in the Receiving Facility y 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. .,.,..ea' .. a one facility within 15 workday to the receiving 2. Enter all information in the form below for.each load of IKG Give one copy of the completed.form s. facility at the time of IKG receipt or mail or deliver the copy to the r g ES 3. Enter the Manifest Number found at the top of this form n the Manifest peg rom box on the generator form where IKG was(collected dorm to 79- .125)-for generator that contributes-to the.load. All generator f generators, make up the load must have the same Manifest Number as the attached Receiving Facility Information form_ I 4. Give the generator copy(from MPES Form 79-125)to the generator at the time of IKG collection or mail or deliver the copy to the generator within.45 calendar days.. 5. Attach the generator forms(MPES Form 79-125)for all generators that contributed to the load of IKG to this form_ Maintain this form and the attached generator forms for two years from the date on this form. ate of IKG Receipt_ Time of IKG Receipt: Type Used Cooking oil I' PM IKG: nterceptorYTrap Grease � Receiving Facility Name: ( B� � o , tie - FIKG lttyAddress: i " � Percentage Fill(if.Required), eived: Measuring MetnUse-d- wiainer Volume(If Required): Gallons Pounds j I e� Vehicle Decal Number: Registered Transporter Name: SIT C12-els ►-�c c.�, b�. ��o ►2a o��- � f��-�03 Driver Name(Printed): Receilring Facility ReprosEnLve Name(Printed): Driver Signature: Recelving Facility Representative Signature: 8T/C0 39vcj Z10100H Oiod 9Z6559b607, LZ:PT bT07,/5T/50