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a nr <br /> CONSTRUiON MATERIALS, INC.G <br /> T. G.I <br /> F.T. G.CONSTRUCTION MATERIALS, INC. r F.95 12F 511 F#WY 12 <br /> 5112 W LODI,CA 95242 <br /> LQDI,CA 95242 <br /> (209)334-4038 (209)334-4038 <br /> � I <br /> DUMP TICKET f F NO. 24081 / DUMP TICKET N0. 24084 <br /> 7- ir/ <br /> DATE 3 TIME DATE - � TIME y <br /> ORIGIN « <br /> DESTINATION i'�1���, ORIGIN <br /> �%'�✓U���f�^� / I DESTINATION <br /> � I I <br /> CONTRACTOR'SCONTR C OR'S OC f S� E/0ieo <br /> NAME/r TO <br /> NAME/B1LLT0 <br /> PHONE NUMBER ) I PHONE NUMBER ) <br /> TRUCK TYPE MATERIAL TYPE <br /> [77TRUCK TYPE MATERIAL TYPE <br /> IClean Asphalt <br /> Minimum ❑ Clean Asphalt ❑ ° Minimum ❑ <br /> 2 Ails ClClean Concrete Er A/ j 2 Axle ❑ Clean Concrete <br /> Clean FII Dirt ❑ r>7 I I 3 Axle ❑ Clean Fill Dirt ❑ <br /> 3 Axle r > <br /> Concrete&Asphalt(Muted OR i� � 5 Axle �$' Concrete&Asphalt(Mixed OR <br /> 5 Axle eonerete&Dirt OR Asphalt&Dirt) ❑ 19,1 <br /> 1` Concrete&Dirt OR Asphalt&Dirt) ❑ <br /> Concrete&Wire or Rebar(rebar& 'j/1 Concrete&Wire or Rebar(rebar& <br /> Wire not to exceed B'beyond concrete) ❑ u r i TRUCK NO Wire not to exceed 6"beyond concrete) ❑ <br /> TRUCK NO E "Contaminated Load(Matenat <br /> "Contaminated Load(Material w/plastic,wood,paper,debris pipe,etc) ❑ <br /> w/plastic,wood,paper,debris pipe,etc) ❑ ; <br /> 'Oversized Loads(over 24'x 24'x 8') ❑ LICENSE NO "Oversized Loads(over 24'x 24'x 8')LICENSE NO <br /> ❑ <br /> 'Excessive RebarC= s 'Excessive Rebar <br /> (Rebar beyond 6'of concrete) <br /> , (Rebar beyond 8 of concrete) ❑ <br /> ❑ I <br /> OTHER ❑ i OTHER ❑ <br /> 'Loads considered"undesirable",maximum rates will be charged <br /> *Loads considered"undesirable",maximum rales well be charged I <br /> The following signature is verification that the material which has been <br /> The following signature is venficabon that the material which has been dumped is not hazardous and that the"material type box"that Is marked , <br /> dumped is not hazardous and that tl�� matenal type bAx"that Is marked is correct <br /> �cone TOTAL DUE <br /> is TOTAL DUE' 49 6 <br /> 1 ro a <br /> LaAIVEWS SIGNATI IRE <br /> IVER SIGNAr E <br /> € OFFICE COPY <br /> OFFICE COPY <br /> � � i =0m M <br />