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PUC T 164702 <br /> BE N SRKHE 29-803866 40543 <br /> P. X 30248 <br /> ST*TON, CALIFORNIA 95213-0248 <br /> r � T� (209)467-0626 (800)843-7056 <br /> aTER1A1.5 INC. �4 F FIV 1 C 115 FLATS•PNEUMATICS•TRANSFERS <br /> SAND•GRAVEL•CEMENT <br /> TRAILER Ido./ <br /> /77T L <br /> UNDERLYING CARRIER COST.P.O.NO. DAT <br /> CONSKi OR CONSFG EE <br /> oN • i/r ,t'IL�''C off" ,;fc-��`� <br /> ADDRESS AD ESS <br /> CITY CITY <br /> NAME AND ADDRESS OF DEBTOR <br /> OF OTHER THAN CONSIGNOR <br /> FOR USE WITH DISTANCE OR ZONE RATES DIST.RATES ONLY <br /> PRECISE <br /> POINT OF /��' _ - DISTANCE <br /> ORGIN / <br /> PRECIMILES <br /> POINTSOF <br /> E ..` /q <br /> DESTVNATION 1.. .__. .._—" •."�.. <br /> 3 49 <br /> 4 <br /> 5 <br /> 6 <br /> 7 <br /> 8 � y <br /> y COMMODITY J k? TYPE OF LOADIN.9 <br /> TRANSPORTED / AT ORIGIN E]POWER ❑ HAND ❑ qTH ER <br /> TIME DRIVER REPORTED LOCATION AT WHICH <br /> FOR WORK DRIVER REPORTED FOR WORK <br /> A STARTING TIME B STARTING TIME OF <br /> UNI OADING OF G OVERALL TIME IFRflM TIME R€- <br /> OF LAST TRIP LAST TRIP PORTING FOR WORK TO START OF <br /> ( LAST TRIP PLUS DOUBLE RUNNING <br /> 1 ENDING TIMEY ENDING UNLTIMOADING <br /> IM TIME OF LAST TRIP PLUS UNLOAD- <br /> OF LAST TRIP OFL AST TF4 TIME <br /> OF LAST TRIP INC TIME OF LAST LOADI <br /> ELAPSED TIME OF ELAPSED TIME OF D,DEDUCTIBLE TIME <br /> THE RUNNING TIME THE--LOADING FOR MEALS OR FAILURE OF <br /> OF LAST TRIP TIME OF LAST TRIP CARRIER EQUIPMENT <br /> REASON FOR DELAY <br /> NET CHARGEABLE TIME <br /> CHARGES <br /> APPLICABLE 1 <br /> HOURLY <br /> CONSIGNOR'S RATE <br /> SIGNATURE RATE <br /> IN CENTS <br /> PER TON <br /> DRIVER'S ACCESSORIAL HELPERS <br /> SIGNATURE <br /> OTHER CHARGES <br /> CONSIGN6-A <br /> SIGNATURE <br /> TERMS:NET 10TH PRQX.'`aSER.� HA RGE OF'2%o P€RAO ass€sSEDON ALL OVERDUE ACCOUNTS <br /> CONSIGNEE AGREES TO PAY ANY LEGAL FEES FOR COLLECTION OF DELINQUENT ACCOUNT <br /> WE MAKE�9LF-B5)lIVERIE5 IN51DE CURB AND ON LOT AT CUSTOMER'S RISK ONLY AND ACCEPT NO RESPONSIBILITY FOR DAMAGES <br /> IN <br /> RESULTG FROM SVCH DELIVERY DUPLICATE -- -- <br />