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9160 'oN N 9 LIOZ l apW sUJI paniaaa� <br /> Inedible Kitchen Grease (IKG) Manifest <br /> Stockton Roto Rooter Grease & Septic Service <br /> Date:7—/ 7 Time: Z AM/PM Manifest#L- Q.G 31) <br /> Business Name: <br /> Job Site Address: �.f� � i.�o s4� Zip Code: �2 <br /> Customer Name(print): ` Q {-P­r7 � %JV*1,(Signature): n av`� <br /> EKG 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 /> Date of IKG Receipt: Time of IKG Receipt: Total IKG Received: <br /> Septic Grease <br /> Receiving Facility Rep.Name(Print) (Signature). <br /> Authorized Transporter: Vehicle Decal Number- <br /> Stockton Roto Rooter Driver Name(print): <br /> 4228 Newton Rd <br /> Stockton,CA 95205 Driver Signature: <br /> Z 'd 911L 'ON NW9 . L [H I 'JpA <br />