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KNIFE RIVER REQUESTED <br />08/27/21 <br />r4�4 REQUESTED DELIVERY TIME: 11:53 <br />aN YOU;tESOURCE5comp"y - " ' ' ORDER NUMBER: 55025 <br />- - - TICKET NUMBER: 1073554 <br />�.:.er _ 'r CYDS DEI: 18.00 <br />Safety First! LOAD if: ..-....2. <br />DRIVER PLANT ID LEAVE PLANT ARRlJE 10@ START POUR END POUR I LEAV6613 I AT PLANT <br />TRUCK ID _--- - [.... _ <br />CIv S <br />" - ` T� — REVf0U5 TRUCK <br />CUSTOMER ACCT IO STONER P.O. ! PR0IECT NO PR01Et"P nAtitE �- LOT 8 @LOCK P � <br />iOlOTO: �DELIVERY ADDRES5/LOCATION: ADDRESS VERIFIED? LLJe • <br />:'URVIANCE DRILLERS INC 5841 E.FREMONT ST <br />'O 8OX 64 <br />INDEN <br />iDOITIONAL DELfVERy INSTRUCTIONS: <br />:/S MC COV & AVALON <br />itY this load Qty Ordered Qty D1vd Product Ccde <br />STOCKTON <br />DRUM REVOLUTIONS <br />BEfilNNING e'vDING TOTAL <br />Product Descnohon UOM Unit Price EXT Amount <br />n-jS1Fr SURCHARGE CY <br />WATP,AQDEli ,ESTIMATED SLUMP STANDBY AND UNLOADING TIME OVERTIME MINUTES ': SUB TOTAL <br />7ulf Load 'LS GAL 51Uh1cEMcess truck time will be assessed by dispatch at the current I SALES TAX <br />?13 Load: 10 GAL. SLUMP rate per minute for orders exceeding five (5) minutes per ADDITIONAL TIME FEE TICKET TOTAL <br />L/!load 7 GAL SLUMP cubic yard. GRAND TOTAL <br />Dt31BI1tSLt1M1P I Alisdu[STED SLUM/ I ACKNOWLEDGEMENT OF RECEIPT, WATER ADDED, & TERMS AND CONDITIONS ON WEB SITE <br />0.00 I_ 6.00 <br />Signature <br />iT, A3l�Ats09 , , RELEASE: Cont tlor of Owners agree to Indemnify and save harmless Knlir River Corporation From Liability imposed as a <br />�yjgol oq damage caused to the property of others as a result of such delivery FOR ADDITIONAL RELEASE <br />i46 MtAlioN:SEEtA WW.KNIFERIVER.COM/NCA FOR PROP 65 INFO WWW.P6SWARNINGS.CA.GOV <br />lI Signature * Printed Name: —._s - <br />fnitfa �v•_ � Waighmater Certificate <br />'HIS IS TO CERTIFY that the ioliow-n. dzsc:X4 ,coa> cdity was weighed, measured Cr counted !;y a seigh:na r , <br />those signature is on the certificate, '-'.o is. Ee`Cogetizzd autnosicy es accuracy, act onalC ode, by Cnist . <br />:commencing with section 12700) of '>: •s= '• 5 fl "the'Califo=nia Business and Ixraiesslatlel Code, administered tsy' <br />:he Division of Measurement Standards cf ,rte California Department of Food and Agriculture. <br />Deputy <br />s <br />