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ti909 '°N MH :E til0 'S [ 'APN awil pania);d <br /> L - Oo'4 � <br /> Inedible Kitchen Grease (IKG) Manifest <br /> Stockton Roto Rooter Grease & Septic Service <br /> Date: -7- Time: AM/PM Manifest 4 L- <br /> I <br /> Business Name: (2 To, 4,- 1 ( o 47n �e-h ,1 <br /> Job Site Address: �3 �-( ra 1'Yla-c i0 CL-rLc Lc Zip Code: <br /> Customer Name (print): f, �, ,• ���-Q- (Signature): <br /> o� <br /> IKG Authorized Receiving Facility Name/Address (circle dump site for facility) <br /> City of Lodi-Whiteslough SPCF <br /> 12751 N. Thornton Rd <br /> Lodi, CA►.95242 <br /> (209)333-6749 <br /> Date of IKG Receipt: L Mime of IKG Receipt: 4,' Total IKG Received: <br /> Septic Grease <br /> Receiving.Facility Rep.Name(Print) B9/APJ W/sEPi? (Signature): <br /> Authorized Transporter: Vehicle Decal Number: <br /> Stockton Roto Rooter Driver Name(print): <br /> 4228 Newton Rd 0 <br /> Stockton,CA 95205 Driver Signature: cAnlh <br /> I <br /> 8T/70 3E)Vd d3ioo�1 010 1 9Z6559769Z LZ:7T 7T9Z/5T/50 <br />