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Site Address: 25726 Fuhrman Rd, Acampo Record ID WP0042250 <br /> Date:7/22/2021 <br /> PHOTO#2 Cement truck receipt. <br /> - /21 <br /> ORDER NUMBER: 55020 <br /> TICKFT NUMBER: 1679578 <br /> www.krnfenver com Ir .«�. -_ vJ..-=JyS CYOS DEL: 6.00 <br /> .Sp etFIPSiI •-0. F.O+ rF/: •a �•:-,. ., 55::05 LOAD at 1 <br /> TRUCK IO DRIVER - PIANT ID LEAVE PLANTARRIVE jog r START POUR END POUR LEAVE JOB <br /> 3- 3416113 RUDY LANDRON I 06 <br /> CUSTOMER ACCT ID CUSTOMER P.O./PROJECT NO. PROJECT NAM LOT&BLOCK PREVIOUS- <br /> 378044 / <br /> SOLD TO: DELIVERY ADDRESS/LOCATION: ADDRESS VERIFIED? Check <br /> VALLEY DRILLING VALLEY;25726 FUHRMAN RD <br /> ACAMPO <br /> ADDITIONAL DELIVERY INSTRUCTIONS: DRUM REVOLUTIO,....:�, <br /> C/S COLLIER RD,PREPAID CC <br /> BEGINNING ENDING TOTAL <br /> MY this Load qty Ordered Qty Dlvd Product code Product Description UOM Unit Price EXT AMOUnt <br /> 6.00 6.CO ..._ SAND SL"PRY yr: L..7.50 945.00 <br /> .-- -_-.. Er•;�n,.:':'y FRe_G'HT 4. -..,...:L _. _�.n7 60.00 <br /> WATER ADDED/ESTI*TED SLUMP STANDBY AND UNLOADING TIME I OVERTIME MINUTES SUB TOTAL 1,005.00 R <br /> Full Load: $77.89 <br /> 2/3 Load: <br /> GAL SLUMP Excess truck time will be assessed b dispatch at the current SALES TAX <br /> GAL SLUMP rate per minute for orders exceeding five(5)minutes per I ADDITIONAL TIME FEE TICKETTOTA $1,082.89 - <br /> 1/3 Load: GAL SLUMP cubic yard. ;s <br /> GRAND TOTAL $1,082.89 <br /> DESIGN SLUMP REQUESTED SLUMP. ACKNOWLEDGEMENT OF RECEIPT,WATER ADDED,&TERMS AND CONOTTIONS ONV EISITE <br /> 4.00 17.00 - � <br /> Signature: Printed Name: <br /> USE OF CONCRETE,AS PLACED: RELEASE:Contractor or Owners agree to Indemnify and save harmless Knife River Corporation from Ility imposed as a <br /> result of any damage caused to the property of others as a result of such delivery.FOR ADDITIONAL 0(EASE <br /> INFORMATION:SEE WWW.KNIFERIVER.COM/NCA FOR PROP 65 INFO WWVV.P65WARNINGS.CA.G ::Vi. ,- <br /> TESTED BY I AIR/SLUMP/TEMP/CPL'S t <br /> Signature: _ Printed Name: <br /> Knife River Weighmaster Certificate <br /> THIS IS TO CERTIFY that the following described ccmm.odity was weighed, measured or counted bya weighmaster, <br /> whose signature is on the certificate, who is a remof Divirecognized authority of accuracy, as prescribed by Chapter 7 <br /> (commencing with section 12700) ion 5 of the California Business and Professional Cede, administered by <br /> the Division of Measurement Standards of the Califorr,La Department of Fcod and Agriculture. <br /> Deputy <br /> Truck Driver User Disp Ticket Num Ticket ID Time Date <br /> 550341643 563397 user 1679578 34187 10:35 7/22/21 <br /> Load SizeMix Code Returned Qty Mix Age Seq Load ID <br /> 6.00 CYD.c 04 D 35836 <br /> Material Des'gn City Required Batched %Var%Moisture Actual Wat <br /> pEIIIV 968 Ib 5808 Ib 5820 Ib 0.21% <br /> TY 1935 Ib 12220 Ib 12240 lb 0.17% 5.25%q <br /> SAND 50.0 gl a 2213.9 91 228.0 gl 0.51% 73 gl <br /> WATER 2280 91 <br /> Num Batches: 1 <br /> Actual 199601b Design W)C: 0430 Water/Cement 0.431 q <br /> Load p Water in Truck: 0.0 gl Adjust Water. 0 ODes1g1 300.0 gl Actual 301.3 gI To Add: 0.0 CI <br /> Loa 7.00 In 91/Load Trim Water, 00 gl I CVDE <br /> 51ur^P' <br /> Page 2 of 2 <br /> Daria Afonskaia, Registered Environmental Health Specialist <br />