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KNIFE <br /> IFE RIVERDATE: 08/16/23 <br /> C47 - REQUESTED DELIVERY TIME: 12:00 <br /> ANMOURESOURCESCOMPANY ELK GROVE ORDER NUMBER: 55027 <br /> Billing OFFICE (209) 933-6980 TICKET NUMBER: 1696976 <br /> www.kniferiver.com Dispatch: (800) 464-6572 / (209) 933-6999 CYDSDEL: 6.00 <br /> Safety First! P.O. BOX 66001, Stockton, CA 95206 LOAD#: 1 <br /> TRUCK ID IDRIVER I PLANT ID LEAVE PLANT ARRIVE JOB START POUR END POUR LEAVE JOB AT PLANT <br /> 550341950 FERNANDO G 06 )2=y <br /> CUSTOMER ACCT ID CUSTOMER P.O./PROJECT NO. PROJECT NAME LOT&BLOCK PREVIOUS TRUCK <br /> 378044 / <br /> SOLD TO: DELIVERY ADDRESS/LOCATION: ADDRESS VERIFIED? L�j Check <br /> VALLEY DRILLING VALLEY; 28600 NORTH SOWLES ROAD <br /> GALT <br /> ADDITIONAL DELIVERY INSTRUCTIONS: DRUM REVOLUTIONS <br /> C/S LIBERTY RD, PREPAID CC <br /> BEGINNING ENDING TOTAL <br /> Qty this Load Qty Ordered Qty Dlvd Product Code Product Description UOM Unit Price EXT Amount <br /> 6. 00 6.00 6.00 504 10. 3 SK. SAND SLURRY yd 192.50 1, 155.00 <br /> 1. 00 554015 FUEL SURCHARGE EA 40.00 40.00 <br /> 6.00 55EFS CEMENT FREIGHT SURCHARGE CY 10.00 60.00 <br /> WATER ADDED/ESTIMATED SLUMP STANDBY AND UNLOADING TIME OVERTIME MINUTES SUB TOTAL 1,255.00 <br /> Full Load: 4L SLUMP Excess truck time will be assessed by dispatch at the current SALES TAX $97.26 <br /> 2/3 Load: GAL SLUMP rate per minute for orders exceeding five(5)minutes per ADDITIONAL TIME FEE TICKET TOTAL $1,352.26 <br /> 1/3 Load: GAL SLUMP cubic yard. GRAND TOTAL $1,352.26 <br /> DESIGN SLUMP REQUESTED SLUMP ACKNOWLEDGEMENT OF RECEIPT,WATER ADDED,&TERMS AND CONDITIONS ON WEB SITE <br /> 4.00 6. 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 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. Deputy <br /> Truck Driver User Disp Ticket Num Ticket ID Time Date <br /> 550341950 575661 user 1696976 51099 12 : 00 8/16/23 <br /> Load Size Mix Code Returned Qty Mix Age Seq Load ID <br /> 6 . 00 CYDE 504 D 53231 <br /> Material Design Qty Required Batched %Var%Moisture Actual Wat Tot.Wat <br /> TYPEII-V 968 Ib 5808 Ib 5780 Ib -0.48% <br /> SAND 1935 Ib 12237 Ib 12200 Ib -0.30% 5.40%A 75 gl 106 <br /> WATER 50.0 gl # 194.8 gl 195.0 gl 0.11% 195.0 gl 195.0 <br /> Actual Num Batches: 1 <br /> Load 19605 Ib Design W/C: 0.430 Water/Cement: 0.433 T Design 300.0 gl Actual 270.0 gl To Add: 30.1 gl <br /> Slump: 6.00 in # Water in Truck: 0.0 gl Adjust Water: 0.0 gl /Load Trim Water: -5.0 gl / CYDE <br />