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ti00� 'ON NV[ [ :OI 9 [0Z '9 'qad ;W1 j paniaa;� <br /> Inedible Kitchen Grease (IKG) Manifest <br /> Stockton Roto.Rooter Grease & Septic Service <br /> D' e: Time: �O- A/PM Manifest# Q <br /> )BBiness Name: Rf I f Jrf6(- P f Z-n <br /> d Site Address:—//O ' YV1 A Y\ Zap Code: —! --4O <br /> C tomer Name(print): � ktl 0'K17 4*f'-1 (Signature): G�� <br /> Authorized ReceivWg Facility Name/Address (circle dump site for facility) <br /> City of Lodi•Whitesiough SPCF <br /> 12751 N. Thornton Rd <br /> Loo CA 95242 <br /> (209)333-6749 <br /> I)I <br /> f IKG Receipt:l—S' Time of IKG Receipt: 2 �/ Total IKG Received- <br /> Septic Greas <br /> Ring Facility.Rep.Name(Print)�� (Signature) <br /> Arized.Tr;nspojrter: Vehicle Decal Number: <br /> T 7/ <br /> Ston �otg'Roorter DriverName(print)• U�(�� �►�✓�� <br /> 42ewton fid 'r <br /> Ston;CA 95205 Driver signature: <br /> 'd [tiL6 'ON AVLz : O [ 2 �0z '9 q <br />