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09SZ "N WKSO : II LIE 6 nON quail pania�aa <br /> Inedible Kitchen Grease (IKG) Manifest <br /> Stockton .Roto ,Rooter Grease & Septic Service � � " dl � <br /> Date: .® O3 f Time: IPM Manifest#L-O L 73 <br /> Business Name: Fuel. y' i eS <br /> Job Site Address: 2�60 b,/ �aLlkN-r\. In Zip Code: <br /> Cu;stower Name (print): /�/Yti�.9'�drJ/�(J� (Signatur <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 Deceived:_ 1� <br /> Septic reale <br /> Re c iving Facility Rep. Name(Print) lel L0�36FKE (Signature): d�CJ <br /> Authorized Transporter: Vehicle Decal Number: dL; <br /> Stockton Roto Rooter Driver Name(print): 1 �-cA Ali <br /> 422 Newton Rd <br /> Stockton,CA 95205 Driver Signature: <br /> d <br /> 9S[6 'ON NW : I I LIOZ '6 'A ON <br />