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BEI SRKHE TD-SOMM 73784 <br /> P O BOX 30248 <br /> 116, C O STOCKTON, CALIFOR141A 95213-0248 <br /> (209)467-0626 (800)843-7056 <br /> 'kiriERIALIO NC 8 E p V I C E FLATS a PNEUMATICS 9 TRANSFERS <br /> ' SAND a GRAVEL•CEMENT <br /> r <br /> i TRAILER <br /> v RR:R CVST PONO DATE <br /> ' C, qq <br /> l vel �nvi/on►P� �S <br /> ' ADOR ADDRESS ` <br /> t-)ClITY fGn�I1/IQ I�� <br /> 1y� 1 CITY <br /> si�C-l��!� G I-LI <br /> NAM ADDRESS OF DEBTOR = <br /> t IIP OTHER THAN COWtY.OR I <br /> FOR USE WITH DISTANCE OR ZONE RATES DIST RATES ONLY <br /> POPfT OF <br /> DISTANCE <br /> ORIGIN + ! IN <br /> MILES <br /> ' PRECISEPOINT OF <br /> I I I 1 <br /> AT10 L(I 4 <br /> .f •Ne <br /> alaLQE <br /> 211 Lop <br /> 3 <br /> r <br /> 5 <br /> I I <br /> 7 I <br /> A.. 9 <br /> COMMODITY T PE OF LOADING <br /> ' TRANSPORTED �! G^ II A ORIGIN []POWER [:]HAND © OTHER <br /> TIME DRIVER REPORTED �( LOCATION AT WHICH <br /> FOR WORK DRIVER REPORTED FOR WORK <br /> A STARTING TIME B VNICANOTIME OF C OVERALL TIME IFKKWI I$ME RE <br /> OF LAST TRIP EAST TRIP t I ' PORTMIO FOR WORK TO START OF <br /> ENDING TIME EHONC.TIME I ._ LAST TRIP PLUS ODUPLE RUNNING <br /> ' OF LAST TRIP UNLOADING TIME TIME OF UST TRIP PLUS LNLOAO <br /> OF LAST TRIP ING TIME OF LAST LCADI <br /> ELAPOtO TIME OF ELAPSED I-E OF D DEDUCTIBLE TIME <br /> THE RUNNIJG TIME TME UNLOAp FOR MEALS OR FAILURE OF <br /> OF LAST TRIP TIME OF LAST TRIP CARRIER ECOMMENT <br /> REASON FOR DELAY <br /> i NET CHARGEABLE TIME I <br /> j CHARGES <br /> r i APPLICABLE <br /> ATE <br /> N <br /> RATE i <br /> CONSIGNOR$ <br /> SIGNATURECENTS <br /> RATE I <br /> TER TON <br /> ' DRIVER 5 ECHARGES HELPERS <br /> SIGNATURE 7�c 4��� - 1VV OTHTHERR CHARGES <br /> CONSIGNEE 5 TOTAL <br /> ' SIGNATURE <br /> TERMS NET 10TH PROX A SERVICE CHARGE of 2% PER Mo ASSESSED ON ALL OVEkOUE ACCOUNTS <br /> CONSIGNEE AGREES TO PAY ANv LEGAL FEES FOR COLLECTION OF OELINOUENT ACCOUNT <br /> RWE MAKE ALL 0EI.IvfAIES ESULTING FROM SUCH OE ms'DE CURB AN06N LQT IITI bl1STQM[R S RISK ONLY ANp ACCEPT NO RESPONSIBILITY FOR DAMAGES <br />