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LOAD ( CUMULATIVE ORDERED 1 ;
GIjANiR CUAB1Tiiy QUANTITY MATERf/lIL CODE PRODUCTION DESCRIPTION
UOM UNIT PRICE AMOUNt h
rE� Wr APR. � fl 110:37
3 11 i �' UEL SURCHARGE
ENV I R.OiVMENTAL, "CHARGE � I
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Cash Check #/AuthCoda: `. Signature river Rem ing636: t
C tlt r s , , Cash Received: Tote COD OrderAmeunt to Coged
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WATERADDED:_._GAL YARDS IN DRUM:______
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WHEN ADDED.
t SIGNATURE )
I� CURB LINE CROSSED AT OWNER'S/AGENT'S REQUEST:
CONC ETE DISPOSAL. FEEi
I PARTIAL _,_� FULL Lp Ib YARDS
SIGNATURE 1
O LOAD WAS TESTED BY:
see. Our dr yers r make every ityf o7ort to place d materials whore thu'cu , Cu des�natos, but the SPECUIL TERMS: Anywater added is ut cuatomorsown risk• If water is added on job; cometo strprrg h
nDa�Y d no raw afty for damogos.inatde curb or Rrepd�t fine, Customer agrees to the is no longer guaranteed, WARNING: Product cause akin and/or eye Irritation. CAUTION: Muterfal
re of sate l d y. this
arid: aaepta of acc accept
as is Due to Impede t tactoq which Bra but of our may be haz3rdoua to your safety and heakh. Please refer to the backskte-of Ihls• tkket for important
me!bol attar del pry, thfs Company w[ft not accept any roapohsibHity fer Itybfinished results. No credit for safety, handling Mtbnmlt on, and to the material safety data sheets for additionalidOof Information.
More o. Boyars ex
cgplions and claims shaft be doemed wale 3d unless made to us in Wddng AUTHORIZED SIGNATURE
In o a busts day after fho rocelpt of materials.
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INII{ ERSA PREY TRK.- 1'U10E'5W47 ANTHONYI.�►NCML.LETTI t
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