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1 � i <br /> F.T. G.CONSTRUCTION MATERIALS, INCA F T. G.CONSTRUCTION MATERIALS,INC. <br /> 5112 W AWY 12 5112 W HWY 12 <br /> ,-LODI,CA 95242 LODI,CA 95242 <br /> (209)334-4038 r (209)334-4038 <br /> c J <br /> DUMP TICKET NO. 40�6 DUMP TICKET N0. 24088 <br /> DATE " cF TIME ' �3 DATE 7^/ J� TpE ; <br /> ORIGIN � —Pd ORIGIN <br /> DESTINATION AIN" 7 DESTINATION <br /> ��IJU//Z O�yf-11,r/- ` CONTRACTOR'S �G`/f-Q CN(1//P0 <br /> CONTRACTOR'S OR'S��'/�v I NAMFJBILL TO <br /> NAME/BILL TO ' <br /> PHONE NUMBER ( ' PHONE NUMBER I <br /> {I TRUCK TYPE MATERIAL TYPE TRUCK TYPE MATERIAL TYPE <br /> i Clean Asphalt ❑ minimum ❑ Clean Asphalt ❑� <br /> Minimum ❑ <br /> 2 Axle ❑ Clean Concrete +8� �� , 2 Axle t ❑ Clean Concrete <br /> I 3 Axle ❑ Clean Fill Dirt D 3 Axle ❑ Clean FIII Dirt ❑ i <br /> Concrete&Asphalt(MbWd ORt �� Concrete&Asphalt(Mixed OR i <br /> 5 Axle Concrete A Dirt OR Asphalt&Dirt) ❑ 5 Axle Concrete&Dirt OR Asphalt&Dirt) ❑ <br /> Concrete&Wire gr Rebar(rebar& Concrete&Ware or Rebar(rebar& <br /> I <br /> TRUCK NO <br /> Wire not to exceed 6'beyond concreteTRUCK NO Wire not to exceed 6'beyond concrete) ❑ ' <br /> ' <br /> 'Contaminated Load(Material "Contaminated Load(Material I ' <br /> wlptastic,wood,paper,debris pipe,etc} ❑ w/plastic,wood,paper,debris pipe,etc) ❑ <br /> LICENSE;NO `Oversized Loads(over 24"x 24'x 8") ❑ j LICENSE NO "Oversized Loads(over 24'x 24'x 8') ❑ <br /> 'Excessive Rebar 'Excessive Rebar <br /> (Rebar beyond 6'of concrete) ❑ 7 (Rebar beyond 6'of concrete) ❑ <br /> OTHER ❑ OTHER t ❑ <br /> *Loads considered"undesirable",maximum rates will be charged *Loads c nsldered"undesirable",maximum rates will be charged <br /> The following signature is verification that the material which has been The following signature is ventication that the matenai which has been <br /> 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 <br /> Is correct TOTAL DUE Is ct �TOTFALX , Xi 3 <br /> I NA RE I R SSIGNATURE <br /> i <br /> CONTRACTOR'S COPY CONTRACTOR'§COPY I <br />