ARCHIVED REPORTS XR0001825 - Laserfiche WebLink

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I < ' _ . T. G. CONSTRUCTION'MATERIALS, INC. F. T. G. CONSTRUCTIdN-NIATERIALS, INC. • - 5112 W HWY 12 5112 W HWY 12 LODI,CA 95242 LODI,CA 95242 (209)334-4038 (209)334-4038 TICKET N0. 2 4 0 9 8 I DUMP TICKET Oil Nab 7 x—hn f p� r O-7-/ 9V TIME / SC DATE S 9J-- — TIME �• 1� r P ORIGIN C- (v 91Z 1-')f-R ZATION l/ T /�-1 DESTINATION _ ACTORS �� F. 0/-�(NT� NAME/BLLTOOS �y/�0 BILI.TO �} NUMBER f,5(so �� `� — PHONE NUMBER ( ) RUCK TYPE MATERIAL TYPE TRUCK TYPE MATERIAL TYPE Infmum C3 Clean Asphalt El minimum IJ Clean Asphalt El Clean Concrete 2 Axle -7, 2 Axle ❑ Clean Concrete-AS- Axle 3 , ❑ Clean Fill Dirt ❑ 3 Axle Clean FII Dirt ❑ OR r Axle ❑ Concrete&Asphalt(Mixed OR 5 Axle Cl Concrete&Dirt OR(Mixed &Dirt ❑ Concrete&Dirt OR Asphalt&Dirt) ❑ p ) Concrete&Wire or Rebar(rebar& Concrete&Wire or Rebar(rebar& RUCK NO Wire not to exceed 6'beyond concrete) ❑ TRUCK NO Wire not to exceed 6"beyond concrete) ❑ 'Contaminated Load(Material 'Contaminated Load(Material w/plastic,wood,paper,debris pipe,etc) ❑ w/plastic,wood,paper,debris pipe,etc) ❑ CENSE NO 'Oversized Loads(over 24'x 24'x 8") ❑ LICENSE NO 'Oversized Loads(over 24'x 24'x 8') ❑ 'Excessive Rebar , T (�Stll 'Excessive Rebar J (Rebar beyond 6'of concrete) C1 _ - (Rebar beyond 6 of concrete) ❑ -SY� OTHER ❑ OTHER ❑ 11 nsldered undesirable maximum rates will be charged *Loads considered undesirable maximum rates will be charged following nature is verification that the material which has been The following signature is verification that the material which has been 1 ardouLdthat the "material type box"that Is marked dumped is not hazardous and that the "material type box" that is marked Is correct TOTAL DUE f n� tTOTAL DUE 3� I v �RIV, 5'5lGNA R V' DRIVER S SIGNATURE �) y ' OFFICE COPY OFFICE COPY 1 1 � 1