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Address: 6550 E. Hwy 12, Lodi Permit: WP0044715 <br /> Well log. Well grouted with 10.3 sack cement mix. <br /> Y t N I FE RIVER DATE: 08/10/13 <br /> _ REQUESTED DELIVERY TIME: 13:00 <br /> aouResouacesCOMPANY ORDER NUMBER: 55060 <br /> .M kniferiver corn 1330873 s/ <br /> - TICKET NUMBER: <br /> a ety First! CYDS DEL: 9.00 "l <br /> 7 __ _ LOAD H: 1 <br /> DRIVER _I PLANT ID I LEAVE PLANT ARRIVE-JOB START POUR END POUR LEAVE JOB AT PLANT f - <br /> ACCT ID CUSTOMERP.O./PROJECT NO PROIFCT f <br /> / NAME <br /> �ifj C / LOT&BLOCK PREVIOUSTRUCK <br /> i0: — <br /> R' — Fl <br /> ELIVERY ADDRESS/LOCATION: ADDRESS VERIFIED? h<:_- <.r i+ <br /> 45TLE WELL& PUMP CASTLE;6337 E.PINE ST <br /> LODI <br /> ADDITIONAL DELIVERY INSTRUCTIONS: <br /> PREPAID CC DRUM REVOLUTIONS <br /> f <br /> Qty this Load — <br /> Qty Ordered Qty Dlvd Product Code Product Description <br /> 7t, 74- <br /> 'f <br /> WATER ADDED/ESTIMATED SLUMP STANDBY AND UNLOADING TIME OVERTIME MINUTES SUB TOTAL 2042.90 ., <br /> GAL SLUMP Excess truck time will be assessed by dispatch at the current SALES TAX $166.50 - f• -- i <br /> 2,3 Loac: GAL SLUMP rate per minute for orders exceeding five(5)minutes per I ADDITIONALTIME FEE TICKET TOTAL 52,211.00 <br /> 11/3 Load: GAL SLUMPI Cubic yard. GRAND TOTAL $2,211.0.0_ . - ._, <br /> DESIGN SLUMP REQUESTED SLUMP ACKNOWLEDGEMENT OF RECEIPT,WATER ADDED,&TERMS AND CONDITIONS ON WEB SITE 00 8.00 <br /> - <br /> � v! <br /> Signature: Printzd 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.KNIFERIVER.COM/NCA FOR PROP 65 INFO WWW.P65WARNINGS.CA.GOV <br /> TESTED BY IAIR/SLUMP/TEMP/CYL'S i_Ly, <br /> Signature: __- _ Frintzd Name: _ ,{� <br /> ghmaster Certizi-ate <br /> Wei <br /> Knife River ♦ °_, <br /> 1 _ <br /> i <br /> Naseem Ahmed, Registered Environmental Health Specialist <br />