Form 79-124 Ikg Manifest Instructions and Receiving Facility Information - California

Form 79-124 is a California Department of Food & Agriculture form also known as the "Ikg Manifest Instructions And Receiving Facility Information". The latest edition of the form was released in August 1, 2017 and is available for digital filing.

Download a PDF version of the Form 79-124 down below or find it on California Department of Food & Agriculture Forms website.

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STATE OF CALIFORNIA
DEPARTMENT OF FOOD AND AGRICULTURE
Meat, Poultry and Egg Safety Branch
00001
Manifest No.:
1220 N Street
Sacramento, CA 95814
(916) 900-5004
79-124 (Est. 08/17)
Manifest - Inedible Kitchen Grease Transport
Instructions and Receiving Facility Information
A complete Inedible Kitchen Grease (IKG) Transport Manifest for a load of IKG consists of this form
and all generator copies from MPES Form 79-125 (Manifest - Inedible Kitchen Grease Transport,
Generator Information) for generators that contribute IKG to the load. Alternatively, the IKG
transporter may use other forms that contain all required information. All forms in each manifest
must have the same Manifest Number. Transporters must keep completed manifests for two years.
Manifest Instructions:
1. The driver of the IKG transport vehicle is responsible for entering all information on this form and on MPES Form 79-
125, Manifest - Inedible Kitchen Grease Transport, Generator Information, except for in the Receiving Facility
Representative and Generator Representative name and signature boxes. All entries must be in ink and legible. The
driver must initial any corrections 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
facility at the time of IKG receipt or mail or deliver the copy to the receiving facility within 15 work days.
3. Enter the Manifest Number found at the top of this form in the Manifest No. box on the generator form (MPES Form
79-125) for each generator that contributes to the load. All generator forms from generators where IKG was collected
to make up the load must have the same Manifest Number as the attached Receiving Facility Information form.
4. Give the generator copy (from MPES Form 79-125) to the generator at the time of IKG collection or mail or deliver the
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 .
Maintain this form and the attached generator forms for two years from the date on this form.
Date of IKG Receipt:
Time of IKG Receipt:
Used Cooking Oil
Type of
IKG:
AM
PM
Interceptor/Trap Grease
Receiving Facility Name:
Receiving Facility Address:
Total IKG Received:
Measuring Method Used:
Container Volume (If Required):
Percentage Fill (If Required):
Gallons
Pounds
Registered Transporter Name:
Vehicle Decal Number:
Driver Name (Printed):
Receiving Facility Representative Name (Printed):
Driver Signature:
Receiving Facility Representative Signature:
STATE OF CALIFORNIA
DEPARTMENT OF FOOD AND AGRICULTURE
Meat, Poultry and Egg Safety Branch
00001
Manifest No.:
1220 N Street
Sacramento, CA 95814
(916) 900-5004
79-124 (Est. 08/17)
Manifest - Inedible Kitchen Grease Transport
Instructions and Receiving Facility Information
A complete Inedible Kitchen Grease (IKG) Transport Manifest for a load of IKG consists of this form
and all generator copies from MPES Form 79-125 (Manifest - Inedible Kitchen Grease Transport,
Generator Information) for generators that contribute IKG to the load. Alternatively, the IKG
transporter may use other forms that contain all required information. All forms in each manifest
must have the same Manifest Number. Transporters must keep completed manifests for two years.
Manifest Instructions:
1. The driver of the IKG transport vehicle is responsible for entering all information on this form and on MPES Form 79-
125, Manifest - Inedible Kitchen Grease Transport, Generator Information, except for in the Receiving Facility
Representative and Generator Representative name and signature boxes. All entries must be in ink and legible. The
driver must initial any corrections 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
facility at the time of IKG receipt or mail or deliver the copy to the receiving facility within 15 work days.
3. Enter the Manifest Number found at the top of this form in the Manifest No. box on the generator form (MPES Form
79-125) for each generator that contributes to the load. All generator forms from generators where IKG was collected
to make up the load must have the same Manifest Number as the attached Receiving Facility Information form.
4. Give the generator copy (from MPES Form 79-125) to the generator at the time of IKG collection or mail or deliver the
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 .
Maintain this form and the attached generator forms for two years from the date on this form.
Date of IKG Receipt:
Time of IKG Receipt:
Used Cooking Oil
Type of
IKG:
AM
PM
Interceptor/Trap Grease
Receiving Facility Name:
Receiving Facility Address:
Total IKG Received:
Measuring Method Used:
Container Volume (If Required):
Percentage Fill (If Required):
Gallons
Pounds
Registered Transporter Name:
Vehicle Decal Number:
Driver Name (Printed):
Receiving Facility Representative Name (Printed):
Driver Signature:
Receiving Facility Representative Signature:

Download Form 79-124 Ikg Manifest Instructions and Receiving Facility Information - California

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