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Site Address: 5828 Fairlane Rd, Acampo CA 95220 <br />Date: 4/8/2021 <br />PHOTO # 2 New Well. Grouted with 10.3 sand cement from 100f ft. <br />f <br />` KNIFE'E{ <br />AN NDU RESOUp CEB COUPANY DATE: D4/08/2I <br />Ri111ng OFFICE ((2099) 933-6980 REQUESTED DER ERY NUMBER: <br />5026 t wwW.kniteriveccom ORDER NUMBER: 55026 <br />Sa ety First! Dispatch: (8 00) q64-6572 ! (209) 933-6999 TICXE7 NUMB ER: 1066487 <br />TRUCKID---_°•�• BOX 66001, Stockton, CA 95205 CYDSDEE: 5,00 <br />DRIVER PLAEgTIp' 1FAVE'PCANT ARRNE IOB STARTPOUR END➢OUR LOLEAVEJOB ATP <br />550341825 HFTURO S ?4DOVAL STCCb:` d'oL5 <br />CUSTOMER ACCT ID CUSTOMER P,O./pROlER NO. D•sJ- (: J <br />378094 r PROJECT NAME Inr a. o,...-„ <br />VALLEY DRILLING <br />VALLEY DRILLING; 5828 FAIRLANE R <br />ACAMPO <br />W/T DRUM REVOLUTIONS <br />IItythisload .Qty Ordered QtyDivd Product Code ------ BEGINNING END iNG <br />5.00 Op - Product Description _ Arno <br />t <br />_.. �. „ UOM Unit Price EXT Amount <br />I ANDBY AND UNLOADING TIME <br />OVERTIME MINUTES SUB TOTAL 912.50 <br />pact: GAL SLUMP Excess truck time will be assessed by dispatch at the current SALES TAX $70.72 <br />2/3 Load. GAL SLUMP rate per minute for orders exceed in five 5 minutes <br />6 l 1 per ADDITIONAL TIME FEE TICKET TOTAL $983.22 <br />1/3 Load: GAL SLUMP cubic yard. <br />j DESIGN SLUMP REQUESTED SLUMPGRAND TOTAL $983.22 <br />0.00 8.00 <br />ACKNOWLEDGEMENT OF RE- WATER ADDED,& TERMS AND CONDITIONS ON WEB SITE <br />USE OF CONCRETE, AS PLACED: Signature: Printed Name: <br />IRELEASE: Contractor or Owners agree to indemnify and save harmless Knife River Corporation from liability Imposed as a <br />result o! any damage caused to the property of others as a result of such delivery. FOR ADDITIONAL RELEASE <br />INFORMATION:SEE WWW.KNIrERIVER.COM/NCA rOR PROP 65 INFO WWW.P65WARNINGS.CA,GOV <br />TESTED BY )AIR/SLUMP,TEMP/CYC$ <br />Knife Ria <br />ver Weighmaster Certificte <br />THIS IS TO CERTIFY that the following described commodity was weighed, measured or counted by a weighmaster, <br />whose signature is on the certificate, who is a recognized authority of accuracy, as prescribed by Chapter 7 <br />(commencing with section 12700) of Division 5 of the California Business and Professional Code, administered by <br />the Division of Measurement Standards of the California Department of Food and Agriculture. <br />Deputy <br />Truck Driver <br />User <br />Disp Ticket Num Ticket ID <br />Time Date <br />550341822 622078 <br />user <br />1066487 95685 <br />10:16 4/8/21 <br />Load Size Mix Code <br />Returned <br />Qty Mix Age Seq <br />Load ID <br />5.00 CYDE 504 <br />D <br />21 <br />;Malenal Design Ory Required <br />Batched <br />% Var% Moisture Actual Wal Tdm <br />TYPEII-V 968.0 Ib 4840.0 Ib <br />4630.0 Ib <br />.0.21% <br />0.86% 5.09%A 496 lb <br />$AND 1936 Ib 10172 Ib <br />CRY 609 Ib 1509 ib <br />10240 lb <br />1502 lb <br />-25.00 I <br />-0.46% 1 11 <br />Actual. _ Num Belches <br />1Aw <br />- <br />- <br />Record ID: WP0041895 <br />Francisco Garcia Ruiz, Environmental Health Asst Page 2 of 3 <br />