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P, C) 6802 "N Wd8l :6 LIOZ til 'Any awil panea�a� <br /> Inedible Kitchen Grease (IKG) Manifest <br /> Stockton Roto Rooter Grease & Septic Service <br /> Date: I Time: Sv /X" Y1 Manifest#L- ©267 <br /> Business Name: "S pkw <br /> Job Site Address: �7 _ �r ®,•cE Ayg—e Zip Code: <br /> Customer Name (print) Signatu e): <br /> IKG Authorized Receiving Facility Name/Address (circle dump site for cility) <br /> City of Lodi-Whiteslough SPCF <br /> 12751 N. Thornton Rd <br /> Lodi, CA 95242 <br /> (209) 333-6749 <br /> Date of CKG Receipt:1�1 Time of YKG Receipt: 1760P Total IKG Received: <br /> Septic Grease <br /> Receiving Facility Rep. Name(Print) Q QS (Signature): <br /> Authorized Transporter: 'Vehicle Decal Number: <br /> Stockton Roto Rooter Driver Name(print): {""``"'"�"" )- <br /> 4228 <br /> 4228 Newton Rd <br /> Stockton,CA 95205 Driver Signature: <br /> 8l 'd S8ti 'ON WdH : z LIE til 'Any <br />