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TRUCK ID DRIVER <br />PLANT ID I <br />DATE: <br />11:35 1 <br />KN I FE RIVE <br />It <br />5503420571 BILL LAY <br />REQUESTED DELIVERY TIME: <br />11:35 <br />AN MDU RESOURCES COMPANY <br />STOCKTON <br />ORDER NUMBER: <br />55015 <br />PROJECT NAME <br />Billing OFFICE (209) 933-6980 <br />TICKET NUMBER: <br />1078000 <br />www.kniferiver.com <br />Dispatch: (800) 464-6572 / (209) <br />933-6999 CYDSDEL: <br />18.00 <br />Safety First! <br />P.O. BOX 66001, Stockton, CA <br />95206 LOAD#: <br />2 <br />TRUCK ID DRIVER <br />PLANT ID I <br />LEAVE PLANT ARRIVE JOB I STARTPOY5 <br />END POUR LEAVE JOB <br />AT PLANT <br />5503420571 BILL LAY <br />STOCK <br />P' / L vJ / 0'� <br />106769 <br />11:16 12/2/21 <br />CUSTOMER ACCT ID <br />CUSTOMER PA: /PROJECT NO. <br />PROJECT NAME <br />ILOT & BLOCK PREVIOUS TRUCK <br />378504 <br />/ESCALONE ESCALON-BELLOTA RD <br />1550341604 <br />TOLD TO: <br />PURVIANCE DRILLERS INC <br />'0 BOX 64 <br />_INDEN <br />DELIVERY ADDRESS/LOCATION: ADDRESS VERIFIED? Check <br />7021 ESACALON-BELLOTA RD <br />LINDEN <br />4DDITIONAL DELIVERY INSTRUCTIONS: <br />SOUTH OFF OF STATE ROUTE 26 <br />DRUM REVOLUTIONS <br />qty this Load Qty Ordered Qty Dlvd Product Code Product Description UOM Unit Price <br />9.00 18.00 18.00 504 10.3 SK. SAND SLURRY yd <br />9.00 55EFS EMERGENCY FREIGHT SURCHARGE CY <br />TOTAL <br />EXT Amount <br />WATER ADDED / ESTIMATED SLUMP STANDBY AND UNLOADING TIME OVERTIME MINUTES SUB TOTAL <br />=ull Load: GAL SLUMP Excess truck time will be assessed by dispatch at the current SALES TAX <br />2/3 Load: GAL SLUMP rate per minute for orders exceeding five (5) minutes per ADDITIONAL TIME FEE TICKET TOTAL <br />1/3 Load: GAL SLUMP cubic yard. GRAND TOTAL <br />DESIGN SLUMP REQUESTED SLUMP ACKNOWLEDGEMENT OF RECEIPT, WATER ADDED, & TERMS AND CONDITIONS ON WEB SITE <br />0.00 6.00 <br />Signature: Printed Name: <br />USE OF CONCRETE, AS PLACED: RELEASE: Contractor or Owners agree to indemnify and save harmless Knife River Corporation from liability imposed as a <br />result of any damage caused to the property of others as a result of such delivery. FOR ADDITIONAL RELEASE <br />INFORMATION: SEE WWW.KNIFERIVER.COM/NCA FOR PROP 65 INFO WWW.P65WARNINGS.CA.GOV <br />-ESTED BY AIR/SLUMP/TEMP/CYL'S <br />Printed Nam <br />(nife River/� Weighmaster Certificate <br />'HIS IS TO CERTIFY that the following de 'cribed ommodity was weighed, measured or counted by a weighmaster, <br />chose signature is on the certificate, o is a recognized authority of accuracy, as prescribed by Chapter 7 <br />;commencing with section 12700) of Division 5 of the California Business and Professional Code, administered by <br />:he Division of Measurement Standards of the California Department of Food and Agriculture. <br />Deputy <br />ruck <br />Driver User <br />Disp Ticket <br />Num Ticket ID <br />Time Date <br />50342057 <br />46614 user <br />1078000 <br />106769 <br />11:16 12/2/21 <br />Dad <br />Size Mix Code <br />Returned <br />Qty <br />Mix Age Seq <br />Load ID <br />.00 <br />CYDE 504 <br />D <br />69 <br />terial <br />Design Qty Required <br />Batched <br />% Var% Moisture <br />Actual Wat Tot.Wat <br />Trim <br />PEII-V <br />968.0 Ib 8712.0 Ib <br />9010.0 Ib <br />+ 3.42% <br />ND <br />1936 Ib 18333 Ib <br />18360 Ib <br />0.15% 5.22% A <br />910 Ib 1219 <br />FY <br />609 Ib 2544 Ib <br />2508 Ib <br />-1.40% <br />2508 Ib 2508 -27.00 gl <br />lual <br />Num Batches: <br />1 <br />ad <br />29878 Ib Design W/C: 0.629 <br />Water/Cement: <br />0.608 T Design <br />5480.3 Ib Actual <br />3418.2 Ib To Add: 20621 Ib <br />imp: <br />6.00 in # Water in Truck: <br />0.0 gl Adjust Water: 0.0 gl / Load <br />Trim Water: -27.0 gl / <br />CYDE <br />