Laserfiche WebLink
F.T. G. CONSTRUCTION MATERIALS, INC <br /> 5112W HWY12 <br /> LODI,CA 95242 <br /> (209)334-4038 <br /> DUMP TICKET NO. 24094 <br /> f <br /> DATE '� TIME r <br />` ORIGIN <br /> DESTINATION <br /> ACTORS <br /> NAME/ ��T�� <br /> NAME/BILL TO <br /> PHONE NUMBER <br /> TRtlCK TYPE MATERIAL TYPE <br /> Minimum ❑ Clean Asphalt 0 <br /> 2 Axle ❑ Clean Concrete ft+ <br /> 3 Axle C1Cfean Fill Dirt ❑ �8c vy -� <br /> Concrete&Asphalt(Mixed OR <br /> 5 Axle Concrete&Dirt OR Asphalt&Dirt) ❑ <br /> Concrete&Wire or Rebar(rebar& <br /> TRUCK NO Wire not to exceed 6"beyond concrete) ❑ <br /> 'Contaminates!Load(Material <br /> w/plastic,wood,paper,debris pipe,etc) ❑ <br /> LICENE O 'Oversized Loads(over 24'x 24"x 8') ❑ <br /> ce 'Excessive Reber <br /> (debar beyond W of concrete) ❑ <br /> OTHER ❑ <br /> "Loads considered undesirabie maximum rates will be charged <br /> The following signature is verification that the material which has been <br /> dumped is not hazardous and that the"material type box"that is marked <br /> is correct rprnt ptJE <br /> RfVER 5 SIGNATURE <br /> OFFICE CQPY <br /> t� <br />