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Address: 13114 DeVries Rd, Lodi Permit: WP0044401 <br /> Well Lo . Well routed with 10.3 sack sand cement mix. Grout seal 200'. <br /> JIA Ey mrsr: P.O. BOX 66001, Stockron, CA 95206 LOAD#: 1 <br /> TRUCK ID DRIVER PLANT ID LEAVE PLANT ARRIVE JOB START POUR END POUR LEAVEJOB ATPLANT <br /> 550341950 FERNANDo G LODI /.`3 1.'ou <br /> CUSTOMER ACCT ID CUSTOMER P.O./PROJECT N0. PROJECT NAME LOT&BLOCK PREVIOUS TRUCK <br /> 378044 / <br /> SOLD TO: DELIVERY ADDRESS/LOCATION: ADDRESS VERIFIED? Check <br /> VALLEY DRILLING VALLEY;13114 DEVRIES RD <br /> LODI <br /> ADDITIONAL DELIVERY INSTRUCTIONS: DRUM REVOLUTIONS <br /> PREPAID CC <br /> BEGINNING ENDING TOTAL <br /> Qty this Load Qty Ordered Qty Divd Product Code Product Description UOM Unit Price EXT Amount <br /> 9.00 9.00 9.00 504 10.3 SK. SAND SLURRY yd 192.50 1,732.50 <br /> 1.00 554015 FUEL SURCHARGE EA 40.00 40.00 <br /> 9.00 55EFS CEMENT FREIGHT SURCHARGE CY 10.00 90.00 <br /> T WATER ADDED/ESTIMATED SLUMP STANDBY AND UNLOADING TIMEOVERTIME MINUTES SUBTOTAL 1,862.50 <br /> Full Load: GAL SLUMP Excess truck time will be assessed by dispatch at the current SALES TAX $144.34 <br /> 2/3 Load: 14ZGAL SLUMP rate per minute for orders exceeding five(5)minutes per ADDITIONAL TIME FEE TICKET TOTAL $2.006.84 <br /> 1/3 Load: GAL SLUMP cubic yard. GRAND TOTAL $2,006.84 <br /> DESIGN LUMP REQUESTED SLUMP ACKNOWLEDGEMENT OF RECEIPT,WATER ADDED,&TERMS AND CONDITIONS ON WEB SITE <br /> 0.00 8.00 <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 I AIR/SLUMP/rEMP/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 />