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t-
<br />Employee #
<br />Employee Name
<br />DATE
<br />{s} tM) rrt (rH) tF) (sA)
<br />Construction, Inc.
<br />TATAL
<br />Gallons of Fuel; On-HwY- Off-HwY-*
<br />lfAccidentwasTrucfi/TrailerLoaded: Yes-- No-
<br />srnnrfl*e ulr.l')
<br />A^^
<br />5T0pTr
<br />*1
<br />Beginnlng
<br />Ending
<br />Accident Yes- No--
<br />DOWN
<br />trl{f
<br />':.,':'tl.:'
<br />':;:..-, T,t..'
<br />1.'.i 4! - tl. !t ..:jr ' j,"
<br />.1,..'i::..-1i
<br />tJl
<br />' ir.;,..:
<br />if.;".' , .-'
<br />'1i w:.'^'.-
<br />'1:'.1'.
<br />r' ,.''.:
<br />: -; !:, ) -..:
<br />:j'j-'.'.'i'.'\
<br />]: ::,'f i1i;1
<br />ofr,v,N6
<br />: . .. .i,. -.j,.a r,..1._.'
<br />tb
<br />p{ 3l(
<br />TNAILER
<br />Lr>g
<br />fxAcToR
<br />rlSz^t
<br />11".:;i;:,i:'::1 "i
<br />,1,-,.1, l;;.. ,.1 :t:.'
<br />r.F.: . ,-i.J.
<br />i-.'1 ;,-1.;1, , ..1rr;r.ti.t.-.:
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<br />tirffi:
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<br />1i j -.'r, ,.r
<br />TOTAL
<br />,{otr85
<br />: -,1;:.r ":,..' .;
<br />". .-,;,:,.
<br />,1;;.,i:1;.i:,11'1
<br />. ,.:,.. . i.. .,
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<br />' '.1, \'....- .'t:'. -r..:. -) ' :
<br />i,.',::-J;j-. .',:'
<br />PAY NATE
<br />t....,\ -:. '
<br />i . .- --'.
<br />:r rr. t'..,.r,:..'
<br />... ,.--. r'..r:i jj
<br />A
<br />I
<br />LAADS
<br />\)Kr*k
<br />\,:Udt'n'tk>
<br />MAIER'AL'IAULED
<br />ir..i-
<br />i:.
<br />":i'
<br />:l'_l-:;
<br />r-.
<br />To ArobdJ
<br />ft{,d)
<br />JOENAFIiE
<br />ifms
<br />JOg #
<br />*6501
<br />Employee Signature Foreman Approval
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