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i <br /> 09SZ '°N AVSO : II MI '6 'noN ;WIj panlaa;� <br /> Inedible. Kitchen Grease (IKG) Manifest <br /> Stockton Roto Rooter Grease & Septic Service <br /> belle: Time; l�9 V PM Manifest#L- 6Z-1q <br /> Business Name: Ve> y,, l2see- <br /> Job Site Address: Zip Code: 5'Zy2 <br /> Cu tomer Name (print): _L4a.QrUj (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 /> Date of IKG Receipt: Time of IKG Receipt: Total IKG Received: <br /> SepticGrease <br /> i <br /> B(21� 6n 6PP- (Signature).Receivin Facility Rep. Name(Print) <br /> Authorized Transporter: Vehicle Decal Number. <br /> Stoc�ton Roto Rooter 1)river Name(print) Ai.w-"V <br /> 4228 Newton Rd <br /> Stockton,CA 95205 Driver Signature: <br /> I <br /> ti d 19S l6 '°N W l : l l t [06 '6 'noN <br />