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r ,� r r r r r■r rr r ■r rl rr �■r� rr r � r 4r ' *► ,` -F. T. G. CONSTRUCTION MATERIALS, INt. 1 F. T. G. CONSTRUCTION MATERIALS INC. x112 W HWY 12 5112 W HWY 12 r g` ' 'LODI,CA 95242 ! LODI,CA 95242 (209)334-4039 S� C f (209)334-4038 "' * DUMP TICKET NO. 24nO t DUMP TICKET NO, 24089 DATE r I TIME J 11 DATE 7 -L � _ TIME 1 ��T � ORIGIN ORIGIN 52/ DESTINATION DESTINATION .�` f � CONTRACTOR _ l CONTRACTOR'S QG �O zti v fd� NAME/BILL O,S U ! NAME/BILLTO PHONE-NUMBER I �' PHONENUMBER ( S TRUCK TYPE MATERIAL TYPE RUCK MATERIAL TYPE Minimum Cl Clean Asphalt [2Minimum ❑ Clean Asphalt 2 Axle ❑ Clean Concrete 2 Axle ❑ Clean Concrete PleW Clean Fill Dirt Cl + 4 3 Axle ❑ Clean Fill Dirt ❑ ; 3 Axle ❑ ) g 5 Axle (� Concrete&Asphalt(Mixed OR Concrete&Asphalt(Mixed OR I Concrete&Dirt OR Asphalt&Dirt) ❑ y 5 Axle Concrete&Dirt OR Asphalt&Dirt) ❑ s Concrete&Wire or Rebar(rebar& 1 I Concrete&Wire or Rebar(rebar& ! TRUCK NO Wire not to exceed 6'beyond concrete) ❑ TRUCK NO Wire not to exceed 6'beyond concrete) ❑ J *Contaminated Load(Material 3 *Contaminated Load(Material w/plastic,wood,paper,debris pipe,etc) ❑ w/plastic,wood,paper,debris pipe,etc) ❑ LICENSE NO Oversized Loads(over 24'x 24'x B") ❑ a LICENSE NO 'Oversized Loads(over 24'x 24'x 8') ❑ t 'Excessive Rebar T3t�S� 'Excessive Rebar Y (Rebar beyond 6'of concrete) ❑ �— (Rebar beyond 6'of concrete) ❑ OTHER ❑ i OTHER ❑ *Loads considered"undesirable",maximum rates will be charged I *Loads considered"undesirable",maximum rates will be charged The following signature is verification that the material which has been The following signature is verification that the material which has been dumped is not hazardous and that the'material type box"that is marked dumped is not hazardous and that the "material type box"that is marked i i Is correct 7 D I is correct 117 7 TOTAL DUE VA"04= & XQAI J O . D /` 'DRIVERS SIGNATURE R S SIGNATURE CONTRACTOR'S COPY CONTRACTOR'S COPY