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ED '°N 021 : 8 E10Z 'S 'AON awil paniaaa� <br /> I. <br /> ri <br /> Inedible Kitchen Grease (IKG) Manifest I <br /> Stockton Roto Rooter Grease & Septic Service <br /> Date: ZjQ f3 Time: 16,'60 4G/PM . Manifest#L-IJ6A7 <br /> I <br /> Business Name: <br /> I <br /> .lob Site Address: 9 7S S• Ta;f ►y1.i���" v e� Zip Code: <br /> Customer Name (print): ignature): <br /> I <br /> XKG 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 /> (249)333-6749 <br /> Date of IKG Receipt: Time of IKG Receipt: Total IKG Received: <br /> S , tic ease <br /> i <br /> Receiving Facility Rep.Name riot) (Signature): <br /> r <br /> Authorized Transporter: 'Vehicle Decal Number: �V In / .I <br /> Stockton Roto Rooter Driver Name(print): Roc'.SfAg.' m( e, <br /> 4228 Newton Rd <br /> Stockton,CA 95205 Driver Signature: <br /> I <br /> I <br /> 1�E <br /> 111 <br /> 90/50 39tid �OiOON OlO�J 9Z6559b60Z GT:80 8TOZ/90/1T <br />