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Site Address: 25203 Magnolia PI, Acampo Record ID WP0042335 <br /> Date: 7/29/2021 <br /> PHOTO#2 Cement truck receipt. <br /> OCKTON UQUEsteD - 07/29/21 <br /> w.yw.knilefiyer.COm el lltng OFFICE 209 DELMRY TIME: 11:30 <br /> I 1 933-69H0 ORDER NUMBER: 55019 <br /> Sa a First! 01 sFa[Ch: (800) 464-6512 J (2091 933-6999 <br /> TICRETN tyi M 1071964 <br /> TRUOt10 1. <br /> BOX 6ti001, Stockt en, CA 95206 �Lnwo R. �� <br /> :DR. . IVER:—_ .0 <br /> SS034i822 AR tDs <br /> URO SANDOVF,L STOCK �:, <br /> 'CUSTOMER ACCT ID. -. ,O,/PROIECi NO. ROJE <br /> ff <br /> 378099 "- / <br /> SOLD TO: <br /> DELIVERY ADDRESS/LOCATION: ADDRESS yERIF1E07 CheC4 <br /> VALLEY DRILLING 25203 MAGNOLIA PLACE <br /> ACAMPO <br /> ITIONAL DELIVERY INSTRUCTIONS: <br /> OLLIER ROAD WEST OF 99,PREPAIDC/C,GATE CODE:3222N _.. DRUM REVOL. <br /> BEGINNING I EN DI r15 TOTAL <br /> 6.00 6.00 6.00 504 .kADlx., 61-11101 <br /> � <br /> 6.00 10.3 SK. SAND SLURRY yd iS.7G 545.00 <br /> SSEFS EMERGENCY FREIGHT SURCHARGE CY 10.00 <br /> 60.00 <br /> WATER ADpED/ESTIMATED SLUMP STANDBY AND UNLOADING TIME ! OVER71M;M17il;TES SUB TOTAL 1,005,00 <br /> Rill Load: GnL SLU',t?� <br /> I 2/3 Load: GAL Excess truck time will be assessed by dispatch at the current SALES TAX $77.89 <br /> SLUM7�rate per minute for orders exceeding Rye(5)minutes per I ADDITIONAL TIME FEE TICKET TOTAL $1,082.89 <br /> 1/3 Lead: GAL ILL'r/PI cubic yard. <br /> DESIGN SLUMP REQUESTED SLUMP GRAND TOTAL 51,082.89 <br /> 0.00 ACKNOWLEDGEMENT OF RECEIPT,WATER ADDED,&TERMS AND CONDITIONS ON WEB SITE: <br /> 7.00 _ <br /> USE OF CONCRETE,AS PLACED: RELEASE C ntract r ur Owners E e t Inden.ndy and sr - — <br /> result Ofa y damage causetl t0 thepope ty of Oth[s as,, esu t of such J C `�a[o from Iiabiluy impo <br /> INFORMATION:SEEWWW.KNIFERIVER.COrd/NCA FOR PROP6 INFO VJ NW y--FOR AODITIOrMLRELEASE - tl-_�.' <br /> TESTED BYIAIR/SLUMP/Tc'MP/CPL'S - - P6SWitlNif {A,OV <br /> Si nature: <br /> Knife River Printed Name: <br /> THIS /S TO CERTIFY that the following described Commodity was 4elghed, measured or counted py��a wo�,Myf Beata <br /> whose signature is on the certificate, who is a recognized on authcrity ct accuracy, as prescribed by Chapter 7 <br /> the <br /> the Division wofhMeasurement section 7Standards 00) of Divof l the SCalifornia l Departmentifornia ofFcodss n and AgricultureCcde, administer ed by <br /> Deputy <br /> Truck Driver User Disp Ticket Num Ticket ID Time Date <br /> 550341822 622078 user 1071968 100976 12:03 7/29/21 <br /> Load Size Mix Code Returned Qty Mix Age Seq Load ID <br /> 6.00 CYDE 504 D 63 <br /> Matenel Design City Required Belched %Val, <br /> %Moisture Actual Wal TotWal Trim <br /> TYPEII-V 988.010 5808.0 Ib 5750.0 Ib -1.00% <br /> SAND 19M Ib 12216 Ib 12240 It, 0.19% 5.17%A 601 Ib 507 <br /> Cm' BN lb 1801 ID 1782 Ib -1.08% 1782 Ib 1782 -25.00 gl <br /> Ctual Num Batches: 1 <br /> oad 18772 th Design W/C: 0629 Water/Cement: 0.635 T Design 3653.5 Ib Actual 23834 Ib To Add. 1270.1 lb <br /> lump: 7.00 in a Water in TrucR: 0.0 gl Adjust Water 0.0 91 1 Load Trim Water. •25.0 gl 1 CYDc, <br /> ILE <br /> Page 2 of 2 <br /> Daria Afonskaia, Registered Environmental Health Specialist <br />