ARCHIVED REPORTS_PUMP RPTS 2017 - Laserfiche WebLink

Home Browse Search

J,rP.r r V r cwt tr�►tN1A _ DEPARTMENT QF FOOD AND AGRICULTUREZ��Z '°N=Wd S l 6 =C l 0 Z= 'l l ';°0-a w i 1 p a n i a a a dI Meat;Poultry and Egg Safety Branch I ;� ]220 N Street - Manifest No:: Sammmeuto,CA 95914 (916)900-5004 - 79-124 (Esc 11/12) 1Vlanif st - Ine"le Kitchen Grease 'Transport Instructions and Receiyi -FaciW Information d y' =A complete T>oedtlxle$itcbleu grease G�Transport Mari fest for a load of 1KG consists of this form f and all generator copies from MPES•^Foam 79-125 Ofitn fest-Inedible Eitchen Grease Transport, Generator Information)for generators that cdaya—b dte 1&G ta'the load_ Alternatively,the IKG transporter may use other forms that contain all required information. AH forms in each manifest must .have the same Rest Ntimber. Transporters'mUst keep completed-mapfirfests-for-two years. I � - it Manifest Instructions: 1.The driver of the IKG transport vehicle is responsible for entering all information on this form and on MPES Form 79- �I :125, Manifest-Inedible 10chen Grease Transport, Generator InforrP;39dn,�zxceptfor in the Receiving Facility �+ Representative and Generator Representative name and signature boxes. All entries must be in ink and legible_ The !� driver mList initial any con-edions.to information already entered; 2- Enter all information in the form below for each load of IKG. Give one copy of the completed form to the receiving faciTdy at the time of IKG receipt or mail or deliver the copyto•ltle receivmg facirity within-16work.days- �f 3. Enter the Manifest Number.found at the top bf this form in the Manifest No. box-on the generator form(MPES Form 7 9- 1` 1255)for each generator that contributes to the•Ioad. All gEne7dq_rforms from generators where IKG was collected,to f make up the lead must have the same Manifest Number as the attached Receiving Facility Information form- l I • 4. Give the generator copy(from MPES Form 79-125)to the generator at the time of IKG collection or mail or deliver the f copy to the generator within 45 calendar days_ 5.Attach the generator forms (MPES Form 79-125)for all generators that contributed to the load of IKG to this form- II Maintain this form and the attached generator forms for two years from the date on this form_ t Date or KG Race Tune of IKG Receipt T ❑ Used Cooking Oil , �/ M > a� / �1 l IKG_ AM Inter�ptorlTrap Grease 1 < <J I i R.6 itMg FaciQty Names. , ()z Receiving PadldyAddressf ` Total IKG Received: ❑ Measuring Method Used. Conla;ner Volume Qf Required): PeMentage Ftli of Required)_ Gallons Pounds /I J l Rogistered Transporter Name: / I Vatfide Decal Number_ pc4c Driver Mame(Printed): RecaMing Faarrty Rapresentative Name(Prkded): a C 6.wSignWDrt Receiving Faality Representative Signature:' J 0 'd OC69 '°N Wd : 6 ClH �O