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Heti 'ON WHSI : 6 LIH II 'jDO aWl j Pani ;3a� <br /> Inedible Kitchen Grease (IKG) Manifest <br /> Stockton Roto R6otear Grease & Septic Service I <br /> Date: .Q Time: <br /> A1VT/PM Manifest#L- <br /> Business Name: fy u.� GG <br /> Job Site Address: �2— Zip Code: `2 <br /> Customer Name(print) ' C,, ( CL LCi� (Signature) <br /> TTG Authorized Receiving Facility Name/Address (circle damp site for facility) <br /> City of Lodi-'PVhiteslough SFCF <br /> 12751 N. Thornton Rd <br /> Lodi, CA 95242 <br /> (209)333-6749 <br /> Date of IKG Receipt Ti ime of I eceipal �Totel IKG Received: <br /> rease <br /> Receiving Facility Rep.Name(Print) LO Signature)- A <br /> Autborized Transporter: Vehicle Decal Number:_ _ <br /> Stockton Roto Rooter DriverName(print) /� <br /> 4228 Newton Rd <br /> Stockton,CA 95205 Driver Siguature: <br /> ti 'd OL69 'ON AVtiZ : 6 LIE l l 'I D0 <br />