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KN I FE RIVE"" <br />t47 <br />DRIVER <br />DATE: <br />21 <br />GG <br />AN I. SOU RESOURCES COMPANY <br />ELK QROVE <br />REQUESTED DELIVERY TIME: <br />11:00 <br />11:00 <br />06 <br />Billing OFFICE (209) 933-6980 <br />ORDER NUMBER: <br />55036 <br />1677348 <br />www.kniferiver.com <br />CUSTOMER P.O. / PROJECT N0. <br />TICKET NUMBER: <br />PROJECT NAM'E'LOT <br />& BLOCK PREVIOUS TRUCK <br />Dispatch: (800) 464-6572 / (209) <br />933-6999 CYDSDEL: <br />5.00 <br />Safetv First! <br />P.O. BOX 66001 . Stncktnn. CIA <br />QS?nr) inanff. <br />I <br />TRUCK ID <br />DRIVER <br />PLANT ID <br />LEAVE PLANT <br />ARRIVE JOB START POUR END OU <br />PR <br />LEAVE JOB AT PLANT <br />550341540 <br />JAVIER CAMACHO <br />06 <br />GAL SLUMP <br />1; <br />CUSTOMER ACCT ID <br />CUSTOMER P.O. / PROJECT N0. <br />PROJECT NAM'E'LOT <br />& BLOCK PREVIOUS TRUCK <br />378044 <br />/ <br />SOLD TO: <br />VALLEY DRILLING <br />DELIVERY ADDRESS/LOCATION: ADDRESS VERIFIED? Check <br />VALLEY;24341 PARTRIDGE LN <br />ACAMPO <br />nvvi i IWIN 1L ULLIVCr%T IIV3I r%Ul.11VIVJ: <br />C/S JAHANT , PREPAID CC <br />Qty this Load Qty Ordered Qty Dlvd Product Code Product Description UOM <br />5.00 5.00 5.00 504 10.3 SK. SAND SLURRY yd <br />WA I ER ADDED/ ESTIMATED SLUMP <br />STANDBY A <br />Full Load: <br />SUB TOTAL 937.50 <br />GAL SLUMP <br />2/3 Load: <br />ADDITIONAL TIME FEE <br />SALES TAX $72.66 <br />TICKET TOTAL $1,010.16 <br />GRAND TOTAL $1,010.16 <br />1/3 Load: <br />GAL SLUMP <br />DESIGN SLUMP <br />4.00 <br />DRUM REVOLUTIONS <br />BEGINNING I ENDING I TOTAL <br />Unit Price EXT Amount <br />157.50 787.50 <br />REQUESTED SLUMP <br />8.00 <br />USE OF CONCRETE, AS PLACED: <br />TESTED BY IAIR/SLUMP/TEMP/CYL'S <br />ACKNOWLEDGEMENT OF RECEIPT, WATER ADDED, & TERMS AND CONDITIONS ON WEB SITE <br />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.KNIFERIVER.COM/NCA FOR PROP 65 INFO WWW.P65WARNINGS.CA.GOV <br />1� <br />Na <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 />550341540 615648 user 1677348 32026 10:33 4/22/21 <br />Load Size Mix Code Returned Qty Mix Age Seq Load ID <br />5.00 CYDE 504 D 33595 <br />Material Design City Required Batched % Var% Moisture Actual Wat <br />TYPEII-V 968 Ib 4840 Ib 4840 lb 0.00% <br />SAND 1935 Ib 10212 Ib 10280 Ib 0.67% 5.55% A 65 gl <br />WATER 73.6 gl 303.6 gl 303.0 gl -0.19% 303.0 gl <br />Actual Num Batches: 1 <br />D ND UNLOADING TIME <br />OVERTIME MINUTES <br />SUB TOTAL 937.50 <br />GAL SLUMP <br />Excess truck time will be assessed by dispatch at the current <br />rate per minute for orders exceeding five (5) minutes per <br />cubic yard. <br />ADDITIONAL TIME FEE <br />SALES TAX $72.66 <br />TICKET TOTAL $1,010.16 <br />GRAND TOTAL $1,010.16 <br />GAL SLUMP <br />GAL SLUMP <br />REQUESTED SLUMP <br />8.00 <br />USE OF CONCRETE, AS PLACED: <br />TESTED BY IAIR/SLUMP/TEMP/CYL'S <br />ACKNOWLEDGEMENT OF RECEIPT, WATER ADDED, & TERMS AND CONDITIONS ON WEB SITE <br />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.KNIFERIVER.COM/NCA FOR PROP 65 INFO WWW.P65WARNINGS.CA.GOV <br />1� <br />Na <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 />550341540 615648 user 1677348 32026 10:33 4/22/21 <br />Load Size Mix Code Returned Qty Mix Age Seq Load ID <br />5.00 CYDE 504 D 33595 <br />Material Design City Required Batched % Var% Moisture Actual Wat <br />TYPEII-V 968 Ib 4840 Ib 4840 lb 0.00% <br />SAND 1935 Ib 10212 Ib 10280 Ib 0.67% 5.55% A 65 gl <br />WATER 73.6 gl 303.6 gl 303.0 gl -0.19% 303.0 gl <br />Actual Num Batches: 1 <br />