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<br />HURLEY ~ <br />i' ~~~ ' <br />I~~ .~ <br />Trttcking <br />6379 Valmont Drive <br />Boulder, Colorado 80301 <br />Phone 442-2131 <br />MATERIALS DIVISION <br />Gross Wt. ~ LrI r <br />~ ~r <br />Tare Wt. - <br />4'~ Cl <br />Net Wt. -' <br />Tons ~~ ~ <br />Time Loaded - <br />Truck Number - <br />Driver <br />Purchaser to sign here it delivery inside curb line <br />Date _! ~ ! ! `!~ <br />Material ve'r, <br />---~~.~ /?'1 -FJ G~1- <br />Code _ <br />Yard Pickup <br />Weighted by 4~ <br />Received by ~ <br />HARLEY <br />~~, '~ <br />~ `f v J R. <br />Trucking <br />6379 Valmont Drive <br />Boulder, Colorado 80301 <br />Phone 442-2131 <br />MATERIALS DIVISION <br />Customer <br />Address <br />Telephone Number <br />r <br />Delivery Access: Purchaser is responsible to provide suitable ways or approaches to point <br />of delivery. Delivery inside curb line is only at Customer's direction and sigrialure. By <br />directing or taking delivery inside curb line Customer agrees to hold harmless Keefer <br />Trucking Co. from all claims and liabilities for damages growing out of such delivery. <br />Purchaser to sign here if delivery inside curb line <br />Date <br />Material <br /> <br />Code <br />Yard Pickup je,,,, <br />Weighted by ~S <br />Received by <br />Customer <br />Address <br />Telephone Number <br />Delivery Access: Purchaser is responsible to provide suitable ways or approaches to point <br />of delivery. Delivery inside curb line is only et Customer's direction end signature. By <br />directing or taking delivery inside curb line Customer agrees to hold harmless Keefer <br />Trucking Co. from all claims end liabilities for damages growing out of such delivery. <br />Material Charge <br />Haul Charge <br />State Tax <br />City Tax <br />Total - <br />,/, <br />Special I t uc~on <br />r <br />2533 <br />NUMBER KY <br />Time Loaded <br />Truck Nurmber <br />Driver 4?~~J <br />Material Charge <br />Total <br />7 Sp iallnstruction <br />TICKET NUMBER KY 2 51 9 <br />-- City Tax <br />