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Address: 24684 Meadow Creek Ct, Acampo Permit: WP0044442 <br /> Well loe. Well erouted with sand cement mix 10.3 sack. <br /> TRUCK ID DRIVER'' PLANT ID" Lt"verLN I nnnivuvu --- - <br /> 550341611 BEN GARCIA LODI <br /> CUSTOMER ACCT ID CUSTOMER P.O./PROJECT NO. PROJECT NAME LOT&BLOCK PREVIOUS TRUCK <br /> 38044 / <br /> SOLD TO: DELIVERY ADDRESS/LOCATION: ADDRESS VERIFIED? Check <br /> • <br /> VALLEY DRILLING VALLEY; 24684 MEADOW CREEK CT <br /> I ACAMPO <br /> r ADDITIONAL DELIVERY INSTRUCTIONS: DRUM REVOLUTIONS a: <br /> CJS WOODSON,PREPAID CC • <br /> 1 <br /> Lc BEGINNING ENDING I TOTAL <br /> �� 6.00 6.00 6.00 504 10.3 SK. SAND SLURRY yd` r 192.50 1,155.00 <br /> 1.00 554015 FUEL SURCHARGE EA 40.00 40.00 <br /> l9- 6,00 55EFS CEMENT FREIGHT SURCHARGE CY 10.00 <br /> 60.00 <br /> WATER ADDED J EST%Mp MD S_WMP STANDBY AND:UNLOADING TIME OVERTIME MINUTES_ SUB TOTAL 1,255.00 <br /> ull Load'. GAL SLUMP 1 <br /> Excess truck time will be assessed by dispatch at the current SALES TAX $97.26 <br /> /3 Load: GAL SLUMP rate per minute for orders exceeding five(5)minutes per ADDITIONAL TIME FEE TICKET TOTAL $1,352.26 <br /> /3 Load: GAL SLUMP cubicyard. GRAND TOTAL <br /> $1,352.26 <br /> DESIGN SLUMP REQUESTED SLUMPJ 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 /> 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. <br /> Deputy <br /> Naseem Ahmed. Registered Environmental Health Specialist <br />