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9080 '°N MtS :� tIol '8 'qaj ;W11 paniaaaa <br /> Inedible Kitchen Grease (IKG) Manifest <br /> Stockton Roto Rooter Grease & Septic Service 4 <br /> �1r36 <br /> Date: ° Time: AM/PM Manifest 4 L- 0 <br /> BusinessName: — <br /> Job Site Address: a4Q k An Zip Code:�� <br /> Customer Namerint <br /> (p ) M)(_Lf�i�S]'gnature): <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 /> Date of IKG Receipt: (� / '+fine of IKG Receipt:- . Total YKG Received: <br /> FP <br /> Dip- <br /> Receiving <br /> Grease <br /> Facility Rep.Name(Print) �j�/ �/�G� (Signature): <br /> Authorized Transpoirter: vehicle Decal Number:,t:77 <br /> Stockton Roto Rooter Driver Name(print): 1?a li1�ll a o�r,6c I, <br /> 4228 Newton Rd <br /> Stockton,CA 95205 Driver Signature: <br /> RECEIVED <br /> SES 0 9 2017 <br /> LAMRONMEWAL 1-MLTH <br /> 8 'd 010L 'ON Wd*S LlH '8 'qad, <br />