Laserfiche WebLink
s�,_�TEoscr ogsuP. 9080 '°N NLS :ti L1Z '8 q awil paniaaa�• <br /> DEPARTMENT OF FOOD AND AGRYh <br /> Meat,Poultry and FyZ Safety R=cfi a Q, <br /> 1220 N Sueot - Manifest No:: <br /> Sacramffaw,CA 95914 - .E8 0 9 2017 <br /> (916).900--5004 1 <br /> 79-124 (Est 11/12) MWIRONMENTAL HMTH 7 <br /> IVB an f-es'rt—J_uedH;1',W1=n "Se Tzansport - r <br /> Ins -n "Ibns and Rece Facility iuforznaion <br /> �A cp ►]ete Xnedi�Ie BiEchen re$'se. Transport Man>1rest for a load of 1SG consists of this form <br /> and aR generator copies from MPES Form 79-125 (Manifest-Inedible Mtche-a.crease Taanspox-b, � <br /> Genexator fxforlaaation)for generators"th tt ivonttibute IgG to:the•load- A.ltercra-tively,the IKG <br /> transporter msp we otbherr:forms that contafn all required.information. AU lforims is each manifest must <br /> 'hav'e the Saone 111a4est Number_ Transpokeri'must keep C`ampieted7manifests fat-two yeai"s- � <br /> 1JManirfast Instructions'- <br /> 1, <br /> nstrucfions_1.The driver of the IKG transport vehicle is responsible for entering all information on tb-*form and on MPES Form 79- II <br /> :125, Manifest-Inedible Kitchen Grease Transport, Generator lnformation,'.exceptfnr in the Receiving Faci ity <br /> Representa&a and Generator RepresentalIve name and sigfralure bones- All entries must be in ink and legible_ The !� <br /> driver must ini al any corrections to informalton already enterad- <br /> 2 E=ater all infarmaUon in the form below for each load of IKG_ Give one copy of the completed form to the race-wing. f <br /> •facTi y at The time of IKG rec i pt or maul or deriver the copy tofhe receiving f dRy within-15-work days_ -f <br /> 3. Enter the Manifest Number found at the top bf this form in the Manffe_st No_ box.on the generator form(MPES Form 79- <br /> -125)for each generaWrthat mntrrbutes to the load_ All generaforforms from generators where IKG was collected to <br /> makeup the load must have the same Manifest Number as the attached Receiving Facility Wbrmatton form_ R <br /> 4. Give the generator copy(from MPES Form 79-125)to the generator at the time of lKG collection or mal or deliver the l <br /> copy to the generator-within 45 calendar days_ <br /> - - I <br /> 5_Attach the generatorforms (MPES Form 79-12 for all generamrs that,contributed to the load of IKG to this form. i <br /> WdntEgn this form and the attaches generator forms ibr two years from the date on this form. <br /> ' 1 <br /> Data of 1KC.R�'?mt Tana of IKG Recorpt= Cooking Oil- . � Type of Used �r- <br /> V' l_ M PM IKG Interr eptorfrrap Grease ` <br /> ( <br /> Rn�FacWly Name= <br /> RecP� g FaaTriyAd <br /> Total IM R�vedd Cations Measunng N3etfrod[L-Ped! Cordainer Votwne'Of Required) Percantago ii i(rf Requit2� <br /> 2-0 v • 0 Pounds �j�!i }��u� � �✓ ��� �I <br /> PegLntsmd Transpvrfer Name= VBhide Dir Number. <br /> Driver Name(FmAero- Receiving FaaTibr Repc2s6nt3five Name(P&O d): <br /> Driver Signafvr� n R,ec.OV Fairi�(Rcprtsa a Sa�rr�bu�' <br /> Ir <br /> _ U7 <br /> l' <br /> �l <br /> I 'll <br /> S 'd 0IOL '°N Wd80 : S LIR 8 qad <br />