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99ti1 'oN WdSI :Z CIOZ— 'S 'A P N IJJ I ' paniaaad <br /> Inedible Kitchen Grease (IKG) Manifest <br /> Stockton Roto Rooter Grease & Septic Service <br /> ©o <br /> Date: -1/-er)—/7 Time: '41:A6 AM/6 Manifest#L- <br /> Easiness Name':�D <br /> Job Site Address: ;Z5-3o / ZV//;,,� loqrXJ:�4r C Zip Code: . 2- <br /> Customer Name(print): ��, ®�C (Signature �Ia-e-k <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 /> L`—/";Z-, -/ 9, 60 <br /> Date of IKG Receipt:�i-7Time of TKG Receipt: 0 Total IKG Received: ®� <br /> epfic Grease <br /> Receiving Facility Rep.Name(print) (Signature): <br /> Authorized Transporter: Vehicle Decal Number: 7 <br /> Stockton Roto Rooter Driver Name(print): <br /> 4228 Newton Rd <br /> Stockton,CA 95205 Driver Signature: <br /> S d I6SL '°N WdH :: LIE 'S 'ASW <br />