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9080 'IN WdLS ti LIOZ 8 qad auil paniaaa� <br /> RECr7N <br /> : .i y 2017 Inedible Kitchen Grease (IKG) Manifest � <br /> -ton Roto Rooter Grease & Septic Service <br /> Date: Ql—31 Time: .r AM 6 Mauffest#L- C) ,� <br /> Business Name- k1. I <br /> .lob Site Address: �d Pu ?,- . cc,, <br /> G z v,2- <br /> Customer <br /> 2Customer Name (print): . ignatur <br /> EKG Authorized Receiving Facility Name/Address (circle dump site for ility) <br /> City of Lodi-Whiteslough SPCF <br /> 12751 N. Thornton Rd <br /> LoA 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.Nawe(Print) ature <br /> Authorized Transporter: 'Vehicle Decal Number: J�""'' <br /> Stockton Roto Rooter Driver Name(print):eEX(i dy �'WLSQ tri <br /> 4228 Newton Rd <br /> Stockton,CA 95205 Driver Signature: <br /> ~ ' <br /> 01 'd ' OIOL '°N WdtiO :S LIH '8 'qad <br />