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iTIONAL DELIVERY INSTRUCTIONS: <br />N FINE <br />PROJECT NAME Lut AELOCK 34132 9 <br />IMER ACCT ID ctsISTO gik P.O. / PROJECT NO. <br />304 <br />TO: <br />MANCE DRILLERS 114C i <br />DELIVERY ADDRESS/LOCATION: <br />21014 COMSTOCK RD. <br />LINDEN <br />PREVIOUS TR <br />550341540 <br />ADDRESS VERIFIED? <br />oglUct COde ProduCt <br />23.00 504 10.3 SK. SAND SLURRY Is icier! <br />.00 <br />STANDBY AND UNLOADING TIME OVERTIME MINUTES SUB TOTAL <br />SALES TAX <br />Excess truck time will be assessed by dispatch at tire current <br />ate per minute for orders exceeding five (5) minutes per ADDITIONAL11ME FEE TICKET TOTAL <br />cubic yard. <br />GRAND TOTAL <br />ACKNOWLEDGEMENT OF RECEIPT, WATER ADDED, & TERMS AND CONDMONS ON V4E8 SITE <br />Signature <br />Printed Name <br />RELEASE: Contractor or Owners agree to Indemnify and save harmless Knife RIVer Corporation from liabty Imposed <br />result of arty damage caused to the property of others as a result of such delivery, FOR ADDITIONAL RELEASE <br />NFORMATION: SEE WWW.KNIFERIVER.COM/NCA <br /> FOR PROP 65 INFO WWW.P65WARNI5GS.CA.GOV <br />AIR/SLUMP/FEW/CYO <br />Printed Name• <br />e River <br /> <br /> <br />lileighmaster Certif 3.c S ature <br />"MIS IS TO CERTIFY that <br />the following described commodity was weighed, measured or counted by a we iqhmastel <br />\. <br /> <br /> phe <br />signature is on the certificate, who is a recognized authority of accuracy , as prescribed by Chapter <br />icortesencing with section 1 2 7 0 0 ) of Division 5 of the California Business and Professional Code, administer <br />the Division of Ilea Sureme n t Standards of the California Department of Food and Agriculture . Del <br />Mum Ticket ID <br />98959 <br />Mix Age Seq Load ID <br />15 <br />Trim <br />Time Date <br />12152 6/17/21 <br />Required Batched % Var% Moisture Actual Wet TOLWat <br /> <br />4840.0 lb 4810.0 lb -0.82% <br /> <br />10187 lb 10380 lb 1.70% 5.24% A 518 lb 690 <br />253A lb 2534 <br /> <br />2537 to 2534 lb -0.14% <br />Design oly <br />Truck Driver <br />550341329 596843 <br />Load Size Mix Code <br />5.00 CYDE 504 <br />User <br />user <br />Returned Qty <br />Disp Ticket <br />1069877 <br />TESTED BY <br />OX 64 <br />1EN DRUM REVOLUTIONS <br />BEGINNING ENDING TOT. <br />EXT AmoUiT <br />WATER ADDED / ESTIMATED SLUMP <br />Full Load: GAL SLUMP <br />SLUMP <br />SLUMP <br />REQUESTED SLUMP <br />6.00 <br />USE OF CONCRETE, AS PLACED; <br />GAL <br />GAL <br />yd <br />2/3 Load <br />1/3 Load <br />DESIGN SLUMP <br />0.00 <br />Address: 21014 Comstock Rd, Linden Petinit: WP0041428 <br />Naseem Ahmed, Registered Environmental Health Specialist