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P.w <br /> DEPAR r OF FOOD AND AGRZCU,[,TVM ' ti 0 0 0 '°N-W d L l :O l 8 l 0 Z' '9 q a J=a ui i 1 p a n i a a�= I <br /> Meat,.Poultry d Egg Safety Branch <br /> ,I <br /> 122-0 N street Manifest fpm':. �� C? <br /> Sacramento,C 95914 <br /> (916)900-500 _ <br /> 79-124 (Fst I IIIir <br /> ?I' <br /> Mau, fest.-•Imedible M:tchen•G•rease''I'rarispor.t <br /> Instrue- ldns and .Reeeiva�ig F'acilyty Information � <br /> 'Ac I aedible Kitchenj�Gre a IKG)Ti2nsport Manifest.for a load of EKG couFists of this form <br /> �.... <br /> .and all genet for copies front." °Form 79-125(Manifest-Inedible 10tehen Grease Trangpoi-4 <br /> -Generator � obrna-tlo>a)fox geziaatox•s'tjWf c0T[jtk Cinte-1KG to therlojj A1ternftt&e1g9 th-e,,IKG, . <br /> transporter y use other forms that contain all required.fnformA.Uom. All forms in each h�iauffest milst <br /> 'have the s Ma est Number_ Tx-ausport dii'&usf lieep")comple>teEiiaaiiffests-fu L vo ye' ' <br /> Maniem I unctions: <br /> 1. The driver c the IKG transport vehicle Is responsible for entering all inforrnabon on this form and on MPES Form 79- <br /> :125, Manifest Inedible Kitchen Grease Transport..Generator•Inform--oration, except.for in thei Receiving FaRw <br /> .Represen and Generator Representative name and s14'rraiture boxes_ All entries must be In ink and I,egiblE_ The <br /> driver'must in' t•any corrections to information already,entered; _ a <br /> 2_ Enter all infi Tnabon in the form below for each load of IKG. Give one copy of the completed form to the receiving ; <br /> favi b 'M ti iebT IKG receipt or mail ordeliver the copy to the rece ling facility within 15•work.days_­ <br /> 3. Enter the M, nifest Number found at the.topaf this form:in the ManVrest No. box on the generator folzri(IMpE5 Form 79- <br /> 125.) for each erator that corttxibutes to the.1oai�_ °All generator forms from_gegerators where IKG was;collected to a j <br /> makeup the lo d must have the same Manifest Number as the.attached Receiving Facility Information form. <br /> I <br /> 4_ Give the get rator copy (from MPES Form 9-125)to the generator at the time of IKG collection or rna,il or deliver the <br /> COPY to the g rMtorwithin 45 Calendar days. <br /> 5. Attach the g nerator forms (MPES Form T9-125)for all generators that contributed to the load of IKG tp'ithis form. <br /> Maintain this and the attached generatorforms fortwo years from the date on this form. <br /> Date of IKG R Time of IKG Receipt Used Coaki'9 Oil <br /> TypE of ❑ I`. <br /> - <br /> 44 PM IKG_ InteroeptoivfW Grease <br /> Reeving Facility me <br /> Rxeivin Faraitcyl w�: I;' !� <br /> Total IKG Re ry Measurin'1 Mg Used. C-6 in Volumo if Re uiriad_ Pamenta e F f If R <br /> Gallons 9 ( 9 ) 9 equired): j l <br /> �1 '� `� ❑ Pounds <br /> i?egi^teied l7atQrNarne! vehicle Decal Number. ' <br /> ,ilk r�i <br /> l <br /> Driver Name(Frio' ): ' - Recahring FacaTdy Represetdalive.Name(Pdntad) <br /> 1 <br /> Driver Signature: . Receiving Facility Reprsssntative Signature_ I <br /> 6 d [tiL6 'ON AVH :U 91H '9 'qac <br />