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IIS _ <br /> BE AR T Fk'OODANDAGRICULZURE "ti008 '°N-WHLl Ol=8l0Z= 9 'gaj�'a'_JI1 panIaaa � <br /> Mea. Fsdaltry 'I a Egg Safety Branch III 51 <br /> b <br /> 17201v sweet Manifest -NO.-: ��(7I�� 0S_ a <br /> Sacramento,c 5814 °— �• u <br /> (916)900-5004 A <br /> 79-124 (Est li/12) ! <br /> i <br /> Maest. --.Inedible <br /> When Gxeae 'J�'rainsport Z <br /> Ynstxucfibns and Receiving FaC ty Information <br /> A c <br /> v�mplete 'tile tcheu, reale�,G)Ttansport Manifest.for a load of 11KG consists ofthis form � <br /> and all gene or copies fromMPES',T,orm 79-125(Manifest-Inedible Kitchen Grease Traiis� 0 1 <br /> Generator rmati6 n)for P ' <br /> ge>oiei tois't}ii fG tr lite TKG to tht-loa(:'Alternatively,the,IKG <br /> transporter y use other forms that contain all required informa#on- All forms ill each�I�i�ifest bxi�st <br /> `have the sawn anifest Number. "Transport6rs must ljeep:complefed ralianifest. for:tvvo yea" <br /> Manifest <br /> - 'I f <br /> Manifest In uEtioins: i <br /> 1. The..driver of a 1K transport vehicle is responsible for entering all information on this form and on MPES Form 79- '! <br /> 125, Manifest-I edible Ktchen Grease Transport:-Generator-Information, exmpt.for in the.Receiving Facility !' <br /> :Representative d Generator Representative name and signature boxes. All entries must be in ink and legible. The 3I� <br /> :driver must,initiany corrections to information almady_entered; :•,! <br /> 2. Enter all info ation in the form below for each load of IKG. Give one copy of the completed form to the.receiving <br /> faoiil�y-at'f'he ti- b-f fKG receipt or mail or'deliver the copy to the receiving facility within'l 6•work;days: <br /> 3. Enter the Ma t Number found.at the.top of this form in the Manifest No. box.on the generator form (IVaFES Form 79- <br /> 125)for each g lerator that contributes to tlje.]oaq_' All generator forms from generators where IKG was c illlected to <br /> make up the low must have the same Manifest Number as the attached Receiving Facility Information fo , <br /> 4. Give the gen for copy (from MPES Form 79-125)to the generator at the time of IKG collection or rnaWo'r deliver the F <br /> copy to the gen r within 45 calendar days. <br /> 5.Attach the ge rotor forms (MPES Form 79-125)for all generators that contributed to the load of IKG to I is form. <br /> 'Maintain this fo and the attached genpratorforms for two years from the date on this form. Ili 1 <br /> Dabe of IKG Receip Time of lKG Receipt <br /> Us <br /> TYPa of ❑ ed Cookir�Oil <br /> I i. <br /> AM PM <br /> IKG: InteroeptorlrJrap Grease <br /> Recetning Facility N <br /> Receiving FacirrtyA <br /> Total IKG Received_ Measuring Method Used: corrtainervolume'(IfRequired)-. Pereontage FIl.If Required)- <br /> Pounds <br /> e uired <br /> Gallons 9 ) <br /> Pounds <br /> C,--//nn ✓u a L(\- C5 �I <br /> RegEt;tamd Transpo rNar»e: I Vehicle decal Numbec <br /> Driver Name(grin kecai,; g Pacll@y Rapne!�;entah a Name(Printed): f <br /> Driver signature; Reing Faarrty RspresoYotive Signature: <br /> ti 'd [tiL6 '°N WHLZ : 01 21OZ '9 qaj 1 <br />