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69H "N Wd8l :Z LIOZ til ' n awil paniaaa� <br /> X12 06 q1 <br /> Inedible Kitchen Grease (IKG) Manifest <br /> Stockton Roto Rooter Grease & Septic Service <br /> Date: Time: AM /PM Manifest#L- <br /> Business Name: M /ooh- G�3� <br /> Job Site Address: r--q Zip Code: `I Z:40 <br /> Customer Name (print . (Signature): <br /> IKG 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 IKG Receipt: 1 3( I / Time of IKG Receipt:J0-N 5 Total IKG Received: I ZOO <br /> Septic ease <br /> Receiving Facility Rep.Name(Print) Vleu) 1,b?�o(� -_(Signature): <br /> Authorized Transporter: 'Vehicle Decal Number: "? <br /> Stockton Roto Rooter Driver Name(print):�r � <br /> 4228 Newton Rd <br /> Stockton,CA 95205 Driver Signature: <br /> til A Hg FON WdH :: LIE 'til .2nd <br />