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6802 'IN M [ :Z LIN 'til 'Snd mull Pani ;); <br /> $TAT)~.OF,CALIFORNUI <br /> DEPARTMENT OF FOOD AND AGRICULTURE = 1 <br /> Meat,Poultry and Egg Safety Branch <br /> 12zo N suer Manifest 'fro:: C4�a_^ <br /> Sacramento,CA 95814 - <br /> J� <br /> (916)900-5004 ] <br /> 79-124 (Est 11/12) <br /> l�ian><fest - Inedible Iitcheo Grease ']['r_#na port L - oz(,- <br /> Instructions <br /> O2(D- <br /> Instructfbns and Rece% ' F'ac i ]Information <br /> ease G <br /> Trans <br /> :A complete 7Aedible Kitchen,Gr port 1Vlanifest.for a load of IXG consists of than form <br /> ,and all generator copies front WES^Form 79-125 (Manifest-Inedible Kitchen Grease Transport; <br /> Generator Informatioilij-for ge ii i atoft th#fjFontriligte XKG to the,16'�rd: ..A:iternatively,the IKG:,.. ; <br /> y use other forms that contain all required information. All forms'in each manifest must �. <br /> xhavesthe same Manifest Number. 'Transporters must beep:compleemaraifest>s for two pears: <br /> . � f <br /> Manifest Instructions: <br /> 1-The driver of the IKG transport vehicle is responsible for entering all information on this form and bn MPES Form 79- <br /> 125, Manifest- Inedible Kitchen Grease Tfansport, Generator Information, except for in thei Receiving Facility <br /> -Representative and Generator Representative name and signature boxes. All entries must be In ink and legible. The <br /> 'driver must Initial any corrections.to information alteady-entered ; ! <br /> 2. Enter all lnforrnation in the form below for each load of IKG. Give one copy of the completed form to the receiving ; <br /> facility'at'trie time of IKG r�ipt or mail or deliver the copy to the receiving faalitywithin-15•work,.days. ;.j <br /> 125 for each a p' if <br /> :I <br /> 3. Enter the Manifest Number found,at the.to bf this form in the Man'est No. box;on the generator form(MPES Form 79- 'a <br /> ) generator that contributes to the.,load.' A I gpnerat;or forms from,generators where IKG was collected to <br /> make up the load must have the same Manifest Number as the attached Receiving facility Information form. <br /> 4. Give the generator copy(from MPES Form 79`125)to the generator et the time of IKG collection or mail'or deliver the i <br /> copy to the generator within 45 calendar days- <br /> 5.Attach the generator forms (MPES Form 79-125)for all generators that contribt,ited to the load of IKG to this form, <br /> Maintain this form and-the attached generator forms for two years from the date on this form. <br /> F <br /> f I G Receipt Time of IKG Receipt' Used Cooking Oil <br /> Type or <br /> Alin P is� <br /> Interceptor/Trap Grease <br /> ing Facility Name: <br /> Receiving FaellityAddrevd. " <br /> c. <br /> Total IKG Received: Measuring Meth6d Used: Cdntalher Volume'(if Required): Percentage Fill(if Required): I ' <br /> �,. Gallons <br /> I) Zl/V Pounds I I 9. <br /> R*stered Transporter Name: <br /> Vehicle decal Number. <br /> -7 ` <br /> rir Name(F1Snted): Receiving Facility Ftepn>58ntatbie Name(Printed): <br /> nature: ` Receiving Fa©Gly Representative Signature: <br /> .9 d SM 'IN Mt :: LIN til '°nH <br />