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� ' <br /> � <br /> � Washington State <br /> Deparlment o� Transportatio� Scaleman's Daily Report <br /> Comracl No. I Oaie <br /> Pd No <br /> ���o - �i _ �r��r� D- 3ys- <br /> Scaie Locafion - <br /> IJo� �kk Lv�''c:� <br /> n�aienais Hauied •� nem No. <br /> ��Z �?�I l� — � s. I o�oo <br /> Slale SCaleman SignaWre CoNraclOr's Scaleman SignaWre � <br /> Morning Tare qftcrnoon Tare <br /> Time_ Truck No. Tare Time I Truck No. Tare <br /> �i��z A� R��3 25 ��o � 2: z�P� t`7 3 2 ��iv <br /> (� o3lAtM �Q � 6�1 Z� �12c� ! Z 2�,��., ({ 169 ZS 8��� <br /> I - <br /> I� ��i r��t �`10 2s �oo r2� oP�� �21�U Zs 6a0 <br /> ( t iZA � Rl � � Z55Go � 2 �2r� /� � � � ?S �t�o <br /> Remarks <br /> CoNraclor's weighman operated the scales and Ihe slale inspeclnr observetl( ) or <br /> weighing operalioas were pedormed by Ihe slate inspector( ) <br /> Scale Tesied By(Company or Agenq) Oate <br /> h�letl-le� Tol��.o / -7 - 2oi � <br /> The reverse side o/this Iorm musf be used�ally fo document scale checking activi(y. <br /> DOT Far.n a12-027 Ef �j <br /> RevlseC91W =, ��f <br /> / <br />