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s7A-IFof -9160 "N N d D :9 t [0 Z l 'a �N a UJi 1 p a n i a�;� <br /> X)FX, RT"11AQNT QF FOOD A.Nil AGWCULTURE <br /> M--r,Poultry and Egg Safety Stanch , <br /> 1�2014 Meer Manifest No:: <br /> Saararrkento,CA 95914 _ T , <br /> (916)900•-5004 _ <br /> 79-124 CR=IU12) <br /> Afa]n f-est-Inedi0kP JI&`itchen Grease 7'r_ari sport - L 02 q o y <br /> Tnctrnclians and Reeeiving-FaciW Information <br /> =A complete Ine(Mle then rcase 1r sport Nkaxpfest fora load of IKG eola lists of this form <br /> end aIl generator copies from MPF {Form 79-125(Manffest InedilbIe Itchen Grease Tramport, <br /> Generator fiaformation)-for generators Fiat cdfitiffifite IKG t6:the load: Alteanativeiy,the ISG <br /> s 'Drier may use other forms that contain a]I xegmlmd haforrioaataon AD.fox-as Stu each xaaxffesf mno-t <br /> '.ave the same Mangest Nb6mber_ 'x'raiasporbers'mnA keep compieted-matiifesi,&fof.two yreai-, I <br /> Manifest Instructions: I <br /> 1.The driver of the IKG'transport vehicle is responsible for Entering all information on this form and on MPES Form 79- <br /> :125, <br /> 9-:925, Manifest-Ined1'ble IGtehen Grease Transport; Generator ln1brmafion4'.except1er in the Rec bang Facility f <br /> Represenfative and Generator Representative name and sighiture boxes_ All entries must be in ink and legible_ The <br /> driver must initial any correcCons.to tn1nrmaf•9on already entered: <br /> r <br /> 2 Enter all information in the form below for each load of IKG. Give one cppy of the completed form to the receiving. <br /> facSity attrle time of IKG rec6ipt or mail or deliverthe copy to-the receiving faellitywrthiri-15 <br /> workdays- <br /> 3. Enter the ManUest Number found at the inp bf this form in the Manifiest No. boron the generator form(MPES Form 79- <br /> :125)for each generatorthat contributes to the load. All generp fforms-from generators where IKG was collected to <br /> make up the load must have the same Manifest Number as the attached Receiving Facility Information forn- <br /> 4: Give the generator copy(from MPES Form 79-125)to the generator at the time of IKG collection or mail or deliver the j <br /> copy to the generator within 45 calendar days_ <br /> 5.Attach the generahorforms(MPES Form 79-125)for all generators that contributed to the load of IKG to this form. I <br /> Maintain this form grid the attached generatorfbrms for two years from the date on this form. <br /> Dab2 of 11CG Reraipt Time of IKG Receiptf-1 Ussd.Cooldng 01 <br /> E l <br /> Type of <br /> �i�M JPM IKGrRerc2ptol/72p Grease I <br /> 1 <br /> RacemW PaatiLyAd \ I <br /> Tobi GAa�. e& C7a11ons Measuring McMod U nd- CorAa7ser Volinr,e(rP Requrrdf1)_ Per®ntage FZIi (rf Requu2d): ,: <br /> pound: <br /> Registered Tramparter Name: \ Vehicle Decal Number_ <br /> Driver Name(Pn Rao6Mng Facey Rapn"sentati,ra Namo <br /> g��Q <br /> � (Pruned)= <br /> D{�rSigrerhire: rtapraaniatia SigW.6- �' <br /> 1 <br /> ti 'd El t '°N Ndo5 : 9 clot l a �N <br />