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DATE: 09/10/21 <br /> "KN I FE RIVER ELK GROVE REQUESTED DELIVERY TIME: 11:00 <br /> AN MDU RESOURCES COMPANY ORDER NUMBER: 55016 <br /> Billing OFFICE (209) 933-6980 TICKET NUMBER: 1680973 <br /> www.kniferiver.com Dispatch: (800) 464-6572 / (209) 933-6999 CYDS DEL: 6.00 <br /> Safety First! P.O. BOX 66001, Stockton, CA 95206 LOAD#: 1 <br /> __.. <br /> TRUCK ID DRIVER PLANT ID LEAVE PLANT ARRIVE 10B START POUR END POUR I LEAVE JOB AT PLANT <br /> 5503419501 FERNANDO G 06 M116 <br /> CUSTOMER ACCT ID CUSTOMER P.O./PROJECT NO. PROJECT NAME LOT&BLOCK PREVIOUS TRUCK <br /> 378044 / <br /> SOLD TO: DELIVERY ADDRESS/LOCATION: ADDRESS VERIFIED? Check <br /> VALLEY DRILLING VALLEY DRILLING; 14141 JAHANT RD <br /> ACAMPO <br /> ADDITIONAL DELIVERY INSTRUCTIONS: DRUM REVOLUTIONS <br /> EAST OF N JACK TONE, PREPAID C/C <br /> BEGINNING ENDING TOTAL <br /> Qty this Load Qty Ordered Qty Dlvd Product Code Product Description UOM Unit Price EXT Amount <br /> 6. 00 6. 00 6.00 504 10.3 SK. SAND SLURRY yd 157 . 50 945.00 <br /> 6. 00 55EFS EMERGENCY FREIGHT SURCHARGE CY 10. 00 60.00 <br /> WATER ADDED ESTIMATED SLUMP STANDBY AND UNLOADING TIME OVERTIME MINUTES SUB TOTAL 1,005.00 <br /> Full Load: GAL SLUMP Excess truck time will be assessed by dispatch at the current SALES TAX $77.89 <br /> 2/3 Load: GAL SLUMP rate per minute for orders exceeding five(5)minutes per ADDITIONAL TIME FEE TICKET TOTAL $1,082.89 <br /> 1/3 Load: GAL SLUMP cubic yard. GRAND TOTAL $1,082.89 <br /> DESIGN SLUMP REQUESTED SLUMP ACKNOWLEDGEMENT OF RECEIPT,WATER ADDED,&TERMS AND CONDITIONS ON WEB SITE <br /> 4.00 7.00 <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 /> TESTED BY�AIR/SLUMP/TEMP/CYL'S <br /> Signature: Printed Name: <br /> Knife River Weighmaster Certificate <br /> THIS IS TO CERTIFY that the following described commodity was weighed, measured or counted by a weighmaster, <br /> whose signature is on the certificate, who 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 /> the Division of Measurement Standards of the California Department of Food and Agriculture. Deputy <br /> Truck Driver User Disp Ticket Num Ticket ID Time Date <br /> 550341950 575661 user 1680973 35549 10 : 23 9/10/21 <br /> Load Size Mix Code Returned Qty Mix Age Seq Load ID <br /> 6. 00 CYDE 504 D 37227 <br /> Material Design Qty Required Batched %Var%Moisture Actual Wat <br /> TYPEII-V 968 Ib 5808 Ib 5820 Ib 0.21% <br /> SAND 1935 Ib 12221 ib 12240 Ib 0.15% 5.26%A 73 gl <br /> WATER 50.0 gl # 226.7 gl 227.0 gl 0.15% 227.0 gl <br /> Actual Num Batches: 1 <br /> Load 19952 Ib Design W/C: 0.430 Water/Cement: 0.430 A Design 300.0 gl Actual 300.4 gl To Add: 0.0 gl <br /> Slump: 7.00 in # Water in Truck: 0.0 gl Adjust Water: 0.0 gl /Load Trim Water: 0.0 gl / CYD£ <br />