Laserfiche WebLink
F <br /> MW fk <br /> F.T. G.CONSIRWCTION MATERIALS, INC. T.T. G. CON9R' ACTION MATERIALS, INC. <br /> 51 W HWY 12 ; 511e HWY 12 <br /> LODI,CA 95242 LODI,CA 95242 <br /> (209)334-4038 , (209)334-4038 <br /> DUMP TICKET N0. 24088 DUMP TICKET N0. 24086 <br /> f <br /> RATE 7^,!/w �� TIME � r � DATE /~ /r�- ! TIME <br /> ORIGIN �C`G 't''C ORIGIN <br /> //�/'f- --- E _ <br /> DESTINATION �Jti�E --- i DESTINATIONyy���'�� <br /> CONTRACTORS [�G'/�Q CN�/j f�� ; NAME/BILL TOO S�=>G�fv 7- 41 <br /> NAME/BILL TO <br /> PHONE NUMBER ) i PHONE NUMBER ( } <br /> TRUCK TYPE MATERIAL TYPE TRUCK TYPE MATERIAL TYPE <br /> Clean Asphalt ❑ Minimum ClClean Asphalt ❑ <br /> Minimum ❑ �` <br /> ' Clean Concrete ' <br /> 2 Axle ❑ Clean Concrete 2 Axle ❑ $Clean Fill Dirt C3pw <br /> 3 Axle ❑ Clean Fill Dirt ❑ r 3 Axle Cl <br /> ` Concrete&Asphalt(Mixed OR <br /> & <br /> 5 Axle <br /> 12,.-- Concrete&Asphalt(Mixed 5 Axle Concrete&Dirt OR Asphalt&Dirt) ❑ <br /> Concrete&Dirt OR Asphalt Dirt) ❑ <br /> Concrete&Wire or Rebar(rebar& Concrete&Wire or Rebar(rebar& <br /> TRUCK NO Wire not to exceed 6'beyond concrete) ❑ TRUCK NO Wire not to exceed 6"beyond concrete) ❑ <br /> 'Contaminated Load(Material ! I 'Contaminated Load(Material <br /> w/plastic,wood,paper,debris pipe,etc) ❑ w/plastic,wood,paper,debris pipe,etc) ❑ <br /> LICENSE NO 'Oversized Loads(over 24'x 24'x 8') ❑ LICENSE NO <br /> 'Oversized Loads(over 24'x 24'x 8') ❑ <br /> p¢- *Excessive Rebar j GT3 95L 'Excessive Rebar <br /> G 7 3 U (Rebar beyond 6'of concrete) ❑ ` (Rebar beyond 6'of concrete) ❑ <br /> OTHER © OTHER ❑ <br /> *Loads considered"undesirable",maximum rates will be charged { "Loads considered"undesirable",maximum rates will be charged <br /> The following signature is verification that the material which has been i 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 ; dumped is not hazardous and that the "material type box"that is marked i <br /> IS ct is correct <br /> ��/ TOTAL DUE i i ITOTAL DUE <br /> i A S SIGNATURE / = 1 i D V $IGNA URE <br /> OFFICE COPY �� OFFICE COPY <br />