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a��T�oF.cALIFo1u� -6802 '0.N=Wd8I :Z -L10til '9ny_auuiI pania�y�ad PS DEITIENT OF FOOD AND AGRICULTURE � y Meat, Poultry and Egg safety Branch 1220 N street Manifest Ido:: ©Caq6� Sacramento,CA 95814 (916)900-5004 79-174 (Bst 11/12) I� Manifests inedible Itchen Grease Transport Instruct ens and Receivbg facility Information L .i.114• ..4'=i.Y i i . ..... .. .v.-. _ i w .1 .. . ... 'A,complete.Ilwedible Kitchen-4lre�se G�DT ansport Manifest.for a load of IKG consists of this form ,and all generator copies from MPES^Form 79-125 (Manifest-Inedible Kitchen Grease Transport, :Generator Tnfoiniation) fot geDierators't1 of 66—fi ibuftTKG td the'loitd., aternatliveYy;the IKG transporter may use other forms that contain all required ivafolrma#on. All forms in each manifest must have the same .�,..,. 11�n>l11`est Number . Transporters must keep=�omple ei >Dpanlifests fox:t�v0 years:. I' Manifest Instruebon3: `. 1. The driver of the IKG transport vehicle is responsible for entering all iniormaAon on this form and on MPES Form 79- 125, Manifest-Inedible Kitchen Grease Transport;-Generator-Iriformation, except.for in the.Receiving Facility Repn�entabve and Generator Representative name and signature boxes_ All entries must be in ink and legible. The driver must initial any corrections to information already.entered; 2. Enter all information in the form below for each load of IKG. Give one copy of the completed form to the receiving 3; fadility at'tile tiMe of lKG receipt or mail ordeliver the copy to the receivingfacilitrty-within,15,work,.days_, 3_ Enter the Manifest Number found.at the top of this form in the Mantfi t No_ box,on the generator form(MPES Form 79- 125)for each generator that corAdbutes to the.;loao..' All generator forms from generators where I KG was collected to make up the load must have the same Manifest Number as the attached Receiving Facility Information form. 4. Give the generator copy (from MPES Form 79-125)to the generator at the time of IKG collection or mail or deliver the copy to the generator within 45 calendar days_ ; 5.Attach the generator forms(MPES Form 79-125)for all generators.that contributed to the load of IKG,to this form_ Maintain this form=and the attached generator forms for two years from the date on this Form. l Date of IKG Receipt Time of IKG Receipt T Used Cooking Oil I. ypn , PM IKG; Interceptor/Trap Grease iving Facility Name: ng Faclilyi4ddr�Et�-``"`"` '� Reeeived: Measuring Method Used Container Volume'(If RequirW): Percentage Fill(if Required): Gallons LiPounds rter'Name' Vehicle Decal Number ' Receiving Facility Representattve Name(Printed): Receiving Facilky Representative Signature: ( _ -I z � d 5s�a 'ON. WdH : Z LIoz 'end