Laserfiche WebLink
r 11■� �r r *r ■r ■Ili r r r r r r urr r 4r r <br /> M,R <br /> 1 � <br /> F.T. G.CONSTRUCTION MATERIALS, INIi. F T. G.CONSTRUCTION MATERIALS, INC. <br /> ,5112 W HWY 12 I 5112 W.-HWY 12 <br /> j LODI,CA 95242 LODI,CA 95242 e <br /> (209)334-4038 (209)334-4038 <br /> r ' <br /> hh <br /> DUMP TICKET NO. 'C H 4 DUMP TICKET NO. 24081 <br /> � <br /> I GATE TIME DATE 3 TIME <br /> a <br /> ORIGIN C!c/io• ORIGIN A4dAk2is i'r <br /> � DESTINATION DESTINATION <br /> CONTRACTORS �C Sp �j Q CONTRACT TD'S l L <br /> NAME/BILL TO <br /> PHONE NUMBER ) PHONE NUMBER _� ) <br /> TRUCK TYPE MATERIAL TYPE TRUCK TYPE MATERIAL TYPE <br /> Clean Asphalt ❑ Clean Asphalt <br /> Minimum ❑ ❑ <br /> ❑ 1[� , <br /> minimum <br /> 2 Axle ❑ Clean Concrete $21e �f/ 2 AxEe� 11Clean Concrete. L ' <br /> 3 A111 I r ❑ Clear(Fill DA Q 1, � y 3 Axie{ � I❑ Clean Fill Dirt <br /> �,, 5 Axle Concrete&Asphalt(Mired OR Concrete&Asphalt(Mixed OR <br /> 5 Axle Concrete&Dirt OR Asphalt&Dirt) ❑ Concrete&Dirt OR Asphalt&Dirt) ❑ <br /> Concrete&Wire or Rebar(rebar& Concrete&Wire or Rebar(rebar& i <br /> TRUCK NO Wire not to exceed 6"beyond concrete) ❑ TRUCK NO Wire not to exceed 6'beyond concrete) ❑ <br /> - *Contaminated Load(Material 'Contaminated LWd(Material <br /> w/plastic,wood,paper,debris pipe,etc) ❑ wlplastic,wood,paper,debris pipe,etc) ❑ <br /> LICENSE NO 'Oversized Loads(over 24'x 24"x 6') ❑ LICENSE NO Oversized Loads(aver 24'x 24'x 8") ❑ <br /> G i /SKJ 'Excessive Rebar G� �a� 'Excessive Rebar 1 <br /> (Rebar beyond 6'of concrete) Ak1barbaymclWof concrete) ❑ 9 <br /> OTHER ❑ QT,ER __ ❑ ) <br /> 'Loads cgnsldered"undesirable maximum rates will be charged *Loads considered"undesirable",maximum rates will be charged <br /> II The following signature is verification that the material which has been The following signature Is verification that the matenal which has been <br /> dumped is not hazardous and that the"material type box"that is marked dumped Is not hazardous and that "material type box"that is marked <br /> is c16�1�GNATVRE <br /> TOTAL DUE Is correct �1 TOTAL DUE ; <br /> y� , 00 <br /> '"0 UER I A7 ' <br /> I <br /> I <br /> I <br /> CONTRACTOR'S COPY I CONTRACTOR'S COPY <br />