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Employee# � I 0 Selland Construction, Inc. <br />Employee Name (ice' <br />Beginning Odometer_ Gallonsof Fuel: On -Hwy. Off -Hwy — <br />Ending Odom <br />Accident: Yes_ No_ If Accident was Truck/Trailer Loaded: Yes_ Na <br />STARTTIME j�" �^ )rOPTIME <br />bv\l <br />Employee Signature _ — 4 WN 1 twl Foreman Approval <br />