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095Z '�N WdSO ll LIOZ '6 AON aril paniaaad <br /> Inedible Kitchen Grease (IKG) Manifest <br /> Stockton Roto Rooter Grease & Septic Service <br /> i <br /> Date: !C7 —2 q Time: �j r J 6 AM/ Manifest#L-0 4� l <br /> i <br /> BusinessName. n <br /> Job Site Address: 62,00 <br /> Zip Code: <br /> Customer Name (print): (Signature <br /> rKG 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 /> Date of[KG Receipt: �ime of IKG Receipt: Total IKG Received: (3 O <br /> I <br /> Septic Grease <br /> Receiving Facility Rep.Name(printW5 P/m WN GP2F (Signature) <br /> i <br /> Authorized Transporter: Vebicle Decal Number: <br /> Stockton Roto Rooter Driver Natne(print): <br /> 4228 Newton Rd <br /> Stockton,CA,95205 Driver Signature: /�V <br /> r <br /> I <br /> I <br /> L 'd 9S [6 'ON A l : l l LIE '6 'A0N <br />