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06 15 HE 'ON Ad 91 Z LIOZ til '2ny ;UJ Ii pani ;D;� <br /> Inedible Kitchen Grease (IKG) Manifest <br /> Stockton Roto Rooter Grease & Septic Service <br /> Date: Time: 0/PM Manifest 4 L- 02 <br /> Business Name: —Lo 41 m ,,-r' 6 0!,l <br /> Job Site Address: � Zip Code: Z4 <br /> Customer Name (print (Signature . <br /> YKG„Authorized Receiving Facility Name/Address (circle dump site for facility) <br /> City of Lodi-Whiteslough SPCF <br /> 12751 N. Thornton Rd <br /> Lodi, CA 95242 <br /> (209) 333-6749 <br /> Date of lKG Receipt: - Time of YKG Receipt: Total IKG Received: <br /> Septic Grease <br /> Receiving Facility Rep. Name(Print) 0ou",l lJ (Signature): Aj 11 <br /> "LStoAuthorized Transporter: Vehicle Decal Number: 7 5-12- <br /> Stockton <br /> ckton Roto Rooter Driver Name(print): . T � <br /> 4228 Newton Rd <br /> Stockton,CA 95205 Driver Signature: CG"sem <br /> Sl 'd 5Dti 'ON WdH :: LIE 'til 'end <br />