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I FE RIS VE <br /> DATE: 12:00/21 <br /> "KNY STOCKTON REQUESTED DELIVERY TIME: 12:00 <br /> AN MOU RESOURCES COMPANY ORDER NUMBER: 55027 <br /> Billing OFFICE (209) 933-6980 TICKET NUMBER: 1069489 <br /> www.kniferiver.com Dispatch: (800) 464-6572 / (209) 933-6999 CYDSDEL: 9.00 <br /> Safety First! P.O. BOX 66001, Stockton, CA 95206 LOAD#: 1 <br /> TRUCK ID DRIVER PLANT ID LEAVE PLANT I ARR!V£JOB START POUR END POUR LEAVE JOB AT PLANT <br /> 550341609 SCOTT C isTOCK <br /> CUSTOMER ACCT ID CUSTOMER P.O./PROJECT NO. PROJECT NAME LOT&BLOCK PREVIOUS TRUCK <br /> 378044 / <br /> S LD TO: DELIVERY ADDRESS/LOCATION: ADDRESS VERIFIED? OCheck <br /> VALLEY DRILLING VALLEY DRILLING; 10283 EAST BRIT <br /> ACAMPO <br /> ADDITIONAL DELIVERY INSTRUCTIONS: DRUM REVOLUTIONS <br /> PREPAID C/C <br /> BEGINNING ENDING TOTAL <br /> Qty this Load Qty Ordered Qty Dlvd- Product Code Product Description UOM Unit Price EXT Amount <br /> 9. 00 9. 00 9. 00 504 10.3 SK. SAND SLURRY yd 157 . 50 1, 417 . 50 <br /> I <br /> I <br /> WATER ADDED/ESTIMATED SLUMP STANDBY AND UNLOADING TIME OVERTIME MINUTES SUB TOTAL 1,417.50 <br /> Full Load: GAL SLUMP Excess truck time will be assessed by dispatch at the current SALES TAX $109.86 <br /> 2/3 Load: GAL SLUMP rate per minute for orders exceeding five(5)minutes per ADDITIONAL TIME FEE TICKET TOTAL $1,527.36 <br /> 1/3 Load: GAL SLUMP cubic yard. GRAND TOTAL $1,527.36 j <br /> DESIGN SLUMP REQUESTED SLUMP ACKNOWLEDGEMENT OF RECEIPT,WATER ADDED,&TERMS AND CONDITIONS ON WEB SITE <br /> 0.00 8.00 <br /> USE OF CONCRETE,AS PLACED: Signature: Printed Name: <br /> RELEASE:Contractor or Owners agree to indemnify and save harmless Knife River Corporation from liability imposed as a <br /> result of any damage caused to the property of others as a result of such delivery.FOR ADDITIONAL RELEASE <br /> INFORMATION:SEE WWW.I<NIFERIVER.COM/NCA FOR PROP 65 INFO WWW;P65WARNINGS.CA.GOV <br /> TESTED BY AIR/SLUMP/TEMP/CYL-S <br /> Signature: Printed Name: <br /> Knife River Weighmaster Certificate <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 User Disp Ticket Num Ticket ID Time Date <br /> 550341609 592378 user 1069489 98583 11 : 45 6/10/21 <br /> Load Size Mix Code Returned Qty Mix Age Seq Load ID <br /> 9 . 00 CYDE 504 D 74 <br /> Material Design Qty Required Batched %Var%Moisture Actual Wat Tot.Wat Trim <br /> TYPEII-V 968.0 Ib 8712.0 Ib 8660.0 Ib -0.60% <br /> SAND 1936 Ib 18301 Ib 18440 Ib 0.76% 5.03%A 883 Ib 1194 <br /> CITY 609 Ib 2726 Ib 2696 Ib -1.10% 2696 Ib 2696 -25.00 gl <br /> Actual Num Batches: 1 <br />