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i <br /> 09SZ "N NdSO : II LIOZ '6 'A0N a W I j paniaaad <br /> Inedible Kitchen Grease (IKG) Manifest r� C <br /> Stockton Roto Rooter Grease & Septic Service <br /> Dat Time: PM Manifest#L-02-7�-- <br /> Bus'ness Name: A�a 's <br /> ,lob Site Address: /0�/ � �t"'I 54-- Zip Code: <br /> Customer Name (print): �Uf k W,'C o-cp, (Signature): <br /> YKG 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 IKG Receipt: I0�2 Time of 1KG Receipt:__b-91KP Total 1KG Received: 2S4 <br /> jSeptic Greas <br /> Rec iving Facility Rep. Name(Print) BkdAIQ �/v� (LL (Signature): r <br /> Aut i orized Transporter: Vehicle Decal Number: vL <br /> Stockton Roto Rooter Driver Name(priot): krl.lr�—'l �✓�� <br /> 42i� Newton Rd <br /> Stockton,CA 95205 Driver Signature: <br /> S 'd 9516 '°N NVti1 : l l LIH '6 'A ON <br />