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Employee f -L5ala <br />[mployee Name {gQ* 7Ir^ d <br />DATE z lt? /zG <br />(s) (M) @ twt frH) {r} (sA} <br />Beginning 375 L6g <br />Ending i1< etqz <br />Accident Yes-.- No K <br />Selland Construction, Inc. <br />E?:3 TOIAL <br />Gallonsof Fuel: on-Hwy ?l' lC2 off'Hwy- <br />STARTTIM e 6:uo srOp rTb <br />xlf Accident was Truck/Trailer l-oaded: 'Gs <br />- <br />No <br />nRIVnn'S DAILY Wil'IE CCFD <br />DOWN <br />NME <br />',:;.::: . <br />at;;.'r i.l. . <br />- :t: .i- <br />' .', -:.:, .. i'...,- <br />.,'.':::i:i ': <br />) ... ,, <br />' ':-, r.1: 1. 1:. <br />:-. 'i'.. <br />DF'V'N6 <br />h;*o <br />INA'tffi <br />,y@ <br />EQU.IPMEt{t <br />IRA€ION <br />ILt77.6 <br />. 'ii...r';1r ,r, <br />2 :': r" ,t'.-':: <br />,:<_?, .. .-:_i_ts-'' <br />'; '. <br />I' <br />..'t.... .:'.'.1' <br />r ir'i'" .i'-t ' <br />'lti1e <br />:-..-' l,:." . ..: - <br />rotAt <br />HOUnS <br />1..-, !r:-l':." j <br />'. '_/.;. ! t.--- <br />".. t.!:- .' ..: <br />' ', .' : .'; r:1:,: <br />. ?.;l .i! i - <br />.:. ! ;: . ;1j <br />:.,1;{' ri;..;,: <br />!..r.r-. -:. <br />PAYRAIE <br />.-.; t,....- ..."': . : <br />". <br />t"l.' <br />LAAAS <br />({ <br />MATTR|,ALH^OLED <br />€ynot* p,r4 <br />Y <br />Hi..i.:+, <br />l"r- . r'"lr;..r..'.1. <br />fto deo <br />Iti:#,, <br />ll t*;i;, <br />l'.:- : ,'.; "'l:i.',i.":-i"' <br />l'j--i r J..', <br />JOBNAMEJAg * <br />z16p-ro <br />Emplcyee Signature 'c Foreman Approval