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�.. , <br /> ' Phone:937-0978I1.1i. No. Phone:937-097 SR KIlC'9951071' <br /> SR KHC 99510735 <br /> woo& REdE <br /> WD' <br /> woo& <br /> Date: L!2 ,� Na: _ Uetc: -r� No: _6_4 Q�} <br /> Point of Origin �.,2�l f�Q_ _ _ _ _ - _ _ _ _ Point of Origin _ _, - �- - - - - - - - - - - - - <br /> TIME: _�_ _ - _ TIME: - <br /> Point of Destination:-H - - - - - - - - Point of Destination:/K.01.Gz - - - - - - - - <br /> Contractors <br /> - _ _ _Contractors Name:- --1,1 - __A?-U-5-4 _ _ _ _ Contractors Name:_ <br /> Material Billed To:_ _ _ _ / U_`9,E- _ _ _ _ Material Billed To:- -- �+~- - - A-u - -- - <br /> No. of lbns or ads: No.of'Ions or arils: _ _ _ ?1_ - -- - -- - - - - - - <br /> TruckNo._ _ _ _ _ _ _ _� IP-z f _ _ _ _ _ _ Truck No._ _ - _ - _ -3A <br /> Truck Owner: _ _ _ _ _ _ _ _ _ &fi_ _ ��..,Q-U-e Truck Owner: _ _ _ _ _ _ _��_ <br /> Drive 's Signature r1 is Signature ~ <br /> I AGS STB G FILLED OL)T COMPLETE[Y- -TAGS UST BE 1LtED OLTr COMPLETELY- <br /> - - •, ._..-.._.._._�...�.�_.._._�_— ..��...__...:.._,...�.��..._, ��.�� <br /> Phone:937-0978 B.E.No. <br /> SR KHC 99510735 <br /> Date: No: 6442 <br /> Point of Origin <br /> TIME: - <br /> Point of Destination:_ ' f,([ _ _l a_b_ <br /> Contractors Name:_ '- &- / Dj - <br /> 4NoMaterial Billed To:_ -- _ - _/C-4- <br /> No. <br /> .of Tons or ar ._ - _ / -0- _ _ - - - - - -1- - - - _ <br /> Truck No._ - - - - _ <br /> Truck Owner: _ it_ <br /> 1rivCr'S Signature <br /> =1AOS MUS' 111i1,11-A-EDOU•1'COMPi.f'1'l1.Y- <br />