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0 Import — <br /> Time <br />Point of Origin k <br />t Point of Destination J.. h <br />Material <br />Date <br />Export . <br />Tric# <br />1') <br /> <br />Lockettird Materials <br /> <br />12505 E;Brandt Rd. No. 6 3 8 2 <br /> <br />Lockeford, eA 95237 • <br />Contractor's Name <br />\-•—\ 15:04,N4 <br /> i <br />Address .1-t/' <br />City <br />State C' Zip <br />Phone # <br />I # of Axles4::: cifyarcis\,. 2,4.2) <br />_ <br />Material: (Please circle) Clean Concrete • Concrete w/Rebar . <br />Mixed load w/o Rebar • Mixed load with Rebar • Clean Asphalt <br />- Other <br />, <br />f " <br />Drive• r's Signature <br />—.7k <br /> <br />l‘Q Underlying Carrier 1;....4 <br />*** Concrete must be less than 24" and mbar must be trimmed flush_ All over- <br />sized concrete will be charged accordingly. ALL contaminated loads will be <br />refused (material with wood, glass, pipe, etc.) All loads must be inspected and a scale tag rcceived. WE RESERVE THE RIGHT TO REFUSE ANY LOAD FOR <br />ANY REASON. <br />NO HAZARDOUS MATERIALS ACCEPTED