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U <br /> F.T.-i. CONSTRUCTION MATERIALS, INC. KF T G. CONSTRU&JOWkATERIALS, INC <br /> 5112 W,HWY12 5112W HWY12 <br /> w LODI,6A 95242 LODI,CA 95242 <br /> (209)334-4038 1 (209)334-4038 <br /> ,I <br /> U TICKET 14 N0. 2 4151DUMP TICKET No. 2 415 3 <br /> 7/ �/�TIME DATE 7J /'� �j TIME <br /> INATION <br /> N NG Gx lI ORIGIN DESTINATION 1' 'l.-WCl?5 9N s <br /> INTI ACTOR'Si' CONTRACTOR S <br /> /BILL TO �G/� (�_ 6_11111,-le-2 /`ll A,,7A NAME/BILL TO <br /> i <br /> E NUMBER ( ) �i PHONE NUMBER ( ) <br /> TRUCK TYPE MATERIAL TYPE j� TRUCK TYPE MATERIAL TYPE <br /> �I <br /> inimum ❑ Clean Asphalt ❑ ,J Minimum ❑ Clean Asphalt ❑ <br /> 2 Axle ❑ Clean Concrete till' Axle ❑ Clean Concrete <br /> Axle Er <br /> Clean Fill Dirt ❑ � 3 Axle ¢}� Clean Fd Dirt ❑ J <br /> Concrete&Asphalt(Mixed OR I 5 Axle ❑ Concrete&Asphalt(Mixed OR ��Y <br /> Axle 13 Concrete <br /> &Dirt OR Asphalt&Dirt) ❑ Concrete&Dirt OR Asphalt&Dirt) ❑ 1 <br /> Concrete&Wire or Rebar(rebar& Concrete&Wire or Rebar(rebar& `Z <br /> RUCK NO Wire not to exceed 6'beyond concrete TRUCK NO❑ Wire not to exceed 6'beyond concrete) C1 ((iI <br /> ) �I <br /> `Contaminated Load(Material; 'Contaminated Load(Material <br /> w/plastic,wood,paper,debris pipe,etc) ❑ w/plastic,wood,paper,debris pipe,etc) ❑ <br /> ICENSE NO "Oversized Loads(over 24'x 24'x 8") ❑ jI LICENSE NO "Oversized Loads(over 24'x 24'x 8") ❑ <br /> 'Excessive Rebar lI S �/ / 'Excessive Rebar <br /> (Rebar beyond W of concrete) ❑ (Rebar beyond 6'of concrete) ❑ <br /> 5 '17 OTHER ❑ OTHER ❑ <br /> Ps,der,d undesirable maximum rates will be charged *Loads considered undesirable maximum rates will be charged <br /> 4no <br /> ture is verification that the material which has been ! The following signature Is verification that the material which has been <br /> rdous and that the"material type box"that is marked �; dumped is n zardous and that the "material type box"that Is marked <br /> TOTAL DUE ! isoorre TOTAL DUE <br /> A9 /�) (?Ri ER S SIGNAT <br /> 1 OFFICE COPY �j OFFICE COPS <br /> 10 <br />