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Decatur Concrete Recycling Aggregate Material <br /> A Div of Mid America Sand &Gravel Delivery Ticket <br /> 2750N Jasper Decatur I.L 217-8754235 <br /> State Inspected <br /> Shipped FronDecatur Unassigned Stock 51155-02 <br /> Ticket# Date Time <br /> Sold Tot 1133 62561 2/1/2012 10:00 <br /> BARR & ROBINSON SEWER AND <br /> JobID:888 MISC. JOB <br /> CITY OF DECATUR BALTIMORE RD <br /> CarrierBARR7 <br /> Product 11 Description Quantity Price Amount <br /> 41 CA7-11 1'WHITE ROCK 13.98 Ton <br /> Tax <br /> Loads: 3 Accum. Amount: 45.56 Ton Total <br /> Gross Weight 48,700 lb <br /> Tare Weight 20,740 lb <br /> Net Weight 27,960 lb <br /> By signing this Delivery Ticket,Driver,individually and as authorized agent of his/her employer,(i)assumes full responsibility for determ ing the proper guar <br /> and weight of materials for transport,and(ii)agrees to indemnify and hold Mid America Sand and Gravel Co.harmless from all claims for peroperty damage <br /> personal injury(indlucing death)arising in any manner out of the transportation or delivery ofthe materials described on the face hereof,including costs of <br /> defense and attorney's tees. <br /> Hauled By: _ Received By: <br /> Sign Full Name. No Initals — <br /> Decatur Concrete Recycling Aggregate Material <br /> A Div of Mid America Sand&Gravel Delivery Ticket <br /> 2750N Jasper Decatur IL 217-875-4235 <br /> Shipped Fron Decatur State Inspected <br /> Sold To: 91133 Unassigned Stock 51155-02 <br /> BARR & ROBINSON SEWER AND Ticket# Date Time <br /> Job ID: 888 MISC. JOB 62561 2/1/2012 10:00 <br /> CITY OF DECATUR BALTIMORE RD <br /> Carrier: BARR7 <br /> Product Description Quantity Price Amount <br /> 41 CA7-11 11WHITE ROCK 13.98 Ton <br /> Loads: 3 Accuun. Amount: 45.56 Ton Tax <br /> Gross Weight 48,7001b Total <br /> Tare Weight 20,7401b <br /> Net Weight 27,9601b <br /> By signing this Delivery Ticket,Driver,individually and as authorized agent of his/her employer,(i)assumes full responsibility for determ ing the proper quar <br /> and weight ofmaterialsfor transport,and(i i)agrees to indemnify and hold Mid America Sand and Gravel Co.harmless from a]I claims for peroperty damage <br /> personal injury(indlucing death)arising in any manner out of tate transportation or delivery of the materials descri bed on the face hereof,including costs of <br /> defense and attorney's fees. <br /> I <br /> Hailed By: _ Received By: <br /> Sign Full Name. Nolnitals <br />