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Employee# Selland Construction, Inc. <br />Employee Name 'MfftPvjq <br />Beginning Odometer 1�YVy" Gallons of Fuel: On -Hwy Off -Hwy <br />Ending Odometer ��� <br />Accident: Yes_ No <br />STARTTIME-77LIM STOPTIME1�' <br />l i" r" <br />If Accident was TruckRailer Loaded: Yes_ No_ <br />Employee signature 1 4 ( �U j—VV � Foreman Approval <br />