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DEPART11 NT OF FOOD AND AGRJC'TTT,TIT�tE ti 0 0� '1 N W H L l :0 l_8 l 0 Z` '9 q a T z u 1 p z n i ' <br /> - I� jell' <br /> Meat"Poultry Egg Safety Branch <br /> 1220 N street Manifest Mer:: �� <br /> Sacramento, 95814 <br /> (916 900-5004 j <br /> 79-124'(F-st 11/12 <br /> 1VXaDif�st.- • iaedib�e I�i��lien,Qrea$e"' ' .a,nsport <br /> Instruc ions and Receiving•Facai�ity linformabion. I 5' <br /> '-A co lete Bible Kitche>}Grp arse G Tuns ort Maxlifest.for a load of]KG consists: f this form <br /> and all gene, for copies froili MPES''T'orm 79-X25 (Manifest-lted�le Kitchen Gres$e Tr !l, oro <br /> -Generator ozniatio>a�"fvr ge�oiez�tors' �f cSY,'frih�itr3 G to ikelaakd.'Alternat�iPeiy;th�1 IKG, . <br /> transporter ay use other forms that coAtafm all required fi ormatiion- ,AH forms Sla eacllt!Illlani�est must <br /> I I! <br /> Ihave the s Manifest Nrlimbelr_ Trimsportess mvct li<eep:elbpleteaFnautfests fOr two years: <br /> Manifest 1 truebons: I' <br /> _ _ I <br /> 1.The driver o the IKG transport vehicle is responsible for entering all information on thisformand onNl �„ES Form 79- <br /> 125, Manifest nedible ICrtchen Grease T ns M.,Generator-Information,. 'exce t for in thd.Receivi F Ili <br /> -Representfffivii nd Generator Representative name a1d'1s r*re boxes. All entrles'must be in ink and l egible. The 3 <br /> =dfiver must.ini 1,any corrections to infarmahon alteady entered; ; °! <br /> 2. Enter all inf anon in the form below for each load of IKG. Give one copy of the completed form to receiving <br /> n 15•,work.d s. ' <br /> faalrll�y at the V e bT fKG recel�or mall or'dellver the copy tothe rece>rring-faclfrty wlthiay "1 j <br /> 3. Enter the M ifest Number found atthe.top,pf this form in the Nlanest No. box;on file generator form'( PES Form 79- <br /> 125)for each nerator that contributes tp the„coact.'°All generator forms from generators where IKG was,icollected to j <br /> makeup the I d must have the same Manifest Number as the attached Receiving Facifrty Information fd., <br /> 4. Give the gel rator copy (from MPES Form 79�-126)to the generator at the time of IKG collection or m1l'or deliver the <br /> copy to the gej I rator within 45 calendar days_ _ I' <br /> 5_Attach the nerator forms (MPES Form 79-125) for all generators that contributed to the load of IKG t this form. .i <br /> Maintain this and-the attached generator forms for two years from the date on this form. <br /> Data of IKG RI Time of IKG Receipt Used 0(I <br /> a ILI <br /> Type of ❑ g I <br /> a <br /> i <br /> ` �� PM IKG: ❑ Interceptal�II�p Gn=u IJ <br /> RL&iWng FadTrty me — _ <br /> 11 _ <br /> Receiving Fadlity' drew'^ <br /> VJA 24 <br /> Total IKG Race Measuring MetFod Used: 'Carifalner Volume"(lfRequirad): Peroehtage I Ili[l(lf Required)= <br /> Gallons <br /> I <br /> Pounds G� r 1(J�C�-f^ <br /> : I <br /> Fzegistered Ttansp erName Vehicle Decal Number. <br /> l ; <br /> Driver Name(1'rin ReceMng FacjfrRj'Represe Name(PrSrrtecl) ' <br /> c,��-�,1Gr1,�� ) . <br /> paver Sign re- 1 Receivin Facirrly Rep entaWo Signature: <br /> L 'd [tiL6 'ON AVH : E EH ,9 gird <br />