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_69H "N WdU :: t 0tl '°nH aWIi p9Aiaaa�:* STAT.QF,CAMFORNIA �I DE,PAxlf MENT OF-FOODAND AGWCULTURE Nkat; Poultry and Egg Safety Branch . � 1220 N St-tet Manifest Mo:; Sacramento,CA 95814 (916)900-5004 79-124 (Fst 11112) Manifestluedible Kitchen G>�eae '�'iran'sport L (� Z 7 � Instructions and Receiving k'aciliiy Information � 'A complete 4wdible Kitchen r' ease )Ti nsport Manifest.for a load of IKG consists of this form ,1 ... ... .. . - 1 . ,an.d all generator copies Brom MPESTorm 79-125 (Manifest-Inedible Kitchen Grease Transport, Generator Inf6rmati6n)'f0ie ge>Qerators'tbiaf'contirll'bate XKG to theJoazi. Alternatively,.the]EKG, . .transporter may use other forms that contain all y required itltfolrloaatlion. All forms in each manifest roust . %ave the same Manirfest Xumber. 'Y'rans ortelrs must keel=co'mpleteil=manifests for`:ttvo years:. Manifest Instructions; 1. The driver of the IKG transport vehicle is responsible for entering all information on this form and on MPES Form 79- ,I _1,25, Manifest-Inedible Kitchen"Grease Transport; Generator•Inform,atlon, except for in the.Receiving Facility :Representative and Generator Representative name ano signature boxes_ All entries must be in ink and legible. The =driver must initial.any corrections to information allteady-entered: _! _ 2. Enter all information in the form below for each load of IKG_ Give one copy of the completed form to the receiving facility at'the Whe dFIKG or mail or'deliver the copy to-the receiving faciritywith in I5-work,.days. 3. Enter the Manifest Number found.at the.top,�f this form in the Manoia No. box,on the generator form(MPES f=orm 79- a 125)for each generator that corttributQs to tlle;load.' All generator forms from.-generators where IKG was collected to make up the load must have the same Manifest Number as the attached Receiving Facility Information form. i 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 fpr two years from the date on this form. Date of IKG Receipt Trme of IKG Receipt Type of Used Cooldng Oil ❑ AMPM IKG' ® Interceptor/Trap Grease 3 i� Rec&iving Facility Name: s ;i Receiving Fecilify Adm- , , , j Total IKG Received: Gallons Measuring Metfiod Used: Cdnt&iner Volume'(If Rsqulmd): Percentage FII(If Required): 3 C.IJ� ❑ Pounds Registered Transporter Na me: Vehicle Decal Number. •J'�I SZ S Dnv®r Name(Printed): R�hring Fadllty Representative Dame(Printed): 8Tatum: Receiving Facility Representative Signature: V 6 'd 588 '0N Wdcz z c01 'en