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1w 3(01I(,PO[LI 'ON AV W2 LIE '6I 'unr aWil paniaaa� <br /> Inedible Kitchen Grease (IKG) Manifest <br /> Stockton Roto Rooter Grease & Septic Service <br /> Date: p r l7 Time: M/PM Manifest#L- QZ G---7 <br /> Business Name: <br /> Job Site Address: l . (/c- Ecr"`Zip Code- <br /> 4-13011" - <br /> ode:11" - <br /> Customer Name (print):per- 1?� (Signature): <br /> I <br /> IKG Authorized Receiving Facility Name/Address (circle dump site for facility) <br /> City of)nodi-Whiteslough SPCF <br /> 12751 N. Thornton Rd <br /> Lodi, CA 95242 <br /> (209) 333-6749 <br /> ,21 <br /> Date of IKG Receipt: 05-0Time of IKG Receipt: Total IKG Received.,aj. <br /> SeptGrease <br /> Receiving Facility Rep.Name(Print) (Signature): <br /> Authorized Transporter: 'Vehicle Decal Number: l <br /> Stockton Roto Rooter Driver Name(print): ' o V 6 6/\ <br /> 4228 Newton Rd <br /> Stockton,CA 95205 Driver Signature: <br /> ti 'd I I6L 'ON Wd9� : 9 LIE '6I 'unr <br />