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09SZ "N NVS0 : 11 LIE '6 AO aW panlaaa� <br /> Inedible Kitchen. Grease (IKG) Manifest <br /> Stockton Roto Rooter Grease & Septic Service <br /> Date:'NO —`�.� �—� Time: ��, � Q/PM Manifest#L- 02-1� <br /> i <br /> Business Name: . <br /> fob Zi Site Address: p Code: <br /> Customer Name (pri , cz,%I F�- G�( � (Signature): <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 /> I <br /> i <br /> Date of IKG Receipt: 9ime of IKG Receipt:e?j1Total 1KG Received:____ <br /> SepticGrease <br /> Receiving Facility Rep. Name(Print) D(Signature): <br /> < <br /> Aut i orized Transporter. Vehicle Decal Number:1 <br /> StocI kton Roto Rooter Driver Name(print)- <br /> 4214 Newton Rd <br /> Sto: ton,CA 95205 Driver Signatu <br /> 6 'd 9516 'ON AVSI : I I LIE '6 'AON <br />