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09SZ "N WNSO : II L1016 n0N au� il paniaaa� <br /> I <br /> Inedible Kitchen Grease (IKG) Manifest <br /> Stockton Roto Rooter Grease & Septic Service <br /> I <br /> Date: WWI Time: AM/6� Manifest#L- � �• <br /> i <br /> I <br /> Business Name: , 'LA–R T <br /> I fip ode:Site Address:-731 J 5� � � <br /> CwItomer Name (print): 1\ (Signature): CaL 4 c <br /> jI <br /> IK6 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 /> pati of IKG Receipt:—/O�-nTime of IKG Receipt. 3b Total IKG Received: �d <br /> Septic Grease <br /> i <br /> Receiving Facility Rep. Name(Print) (Signature): <br /> Authorized Transporter: Vehicle Decal Number: <br /> Stockton Roto Rooter Driver Name(print): J-L . .,- <br /> 4226 Newton Rd <br /> Stoclkton,CA 95205 Driver Signature: <br /> I <br /> I <br /> I <br /> I <br /> I <br /> I <br /> 11 'd 9S16 'ON WdS 1 : l l L I H '6 'n ON <br />