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9618 'IN WHBI 6 8l0Z Zl 'a "W a"!1 paniaaa� <br /> Inedible Kitchen Grease (H,(_G) Manifest <br /> Stockton Roto Rooter Grease & Septic Service <br /> bate: 'a r Time: A1Vi/PM: Manifest#L U Zq <br /> Business Name: qU <br /> /4 <br /> Job Site Address: D--/ Sr_L,.fJZip Code: 5 <br /> Customer Name (print): Sign tore): <br /> MG Authorized Receiving Facility Name/Address (circle dump site for facility) <br /> City of Lodi-`4Vhiteslough SPCF <br /> 12751 N. Thoriatou Rd <br /> Lodi, CA 95242 <br /> (209) 333-6749 <br /> 2 <br /> I(� �S�U <br /> Datc of[KG Roceipt.� Time of II<G Receipt: Total II';Gi Received: <br /> Septic ®re se <br /> Receiving Facility Rep.Name(Print) V` Q! QS__(Signature). <br /> Authorized Transporter: 'Vehicle Decal Number:, / -7 5 <br /> Stockton Moto );tooter Driver Name(print): <br /> 4226 Newton T2.d , <br /> Stockton,CA,95205 Driver Signature: <br /> 9 'd 5L96 'ON Wd6Z : 6 91H <br />