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ED "N NMI E 0 'S 'AON ;w 'I pania�a� <br /> �-- Da <br /> Inedible Kitchen Grease (IXG) Manifest <br /> Stockton Roto Rooter Grease & Septic Service <br /> Date: 101711- Time: •�l AM/PM Manifest 9 L-�(=q <br /> p r <br /> Business Name: <br /> Job Site,Address: l20 S t Ck P dr-Yc 1 ? Zip Code: <br /> Customer Name(print): (Signature)• <br /> MG Authorized Receiving Facility Name/Address (circle dump site for facility) <br /> City of Lodi-Whiteslough SPCF <br /> 1.2751 N.Thornton Rd <br /> Lodi, CA 95242 <br /> (209)333-6749 <br /> Date of IKG Receipt: IP1711-3 Time of MG Receipt: le`C'O Total IKG Received: <br /> Septic Grease <br /> Receiving Facility Rep.Name(Print) (Signature): <br /> Authorized Transporter: Vehicle Decal Number: 3 I <br /> Stockton Roto Rooter Driver Name print): noSaJ4 �2, <br /> 4228 Newton ltd <br /> Stockton,CA 95205 Driver Signature:_ , <br /> i <br /> i <br /> 90/Z0 391Vd �Giooz1 010 1 9Z6559V60Z 6T :80 STOZ/50/TT <br />