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WP0039867
EnvironmentalHealth
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12 (STATE ROUTE 12)
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13550
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4200/4300 - Liquid Waste/Water Well Permits
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WP0039867
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Entry Properties
Last modified
11/19/2024 3:48:24 PM
Creation date
9/6/2019 3:30:50 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
WP0039867
PE
4370
STREET_NUMBER
13550
Direction
W
STREET_NAME
STATE ROUTE 12
City
LODI
Zip
95242-
APN
05502002
ENTERED_DATE
7/25/2019 12:00:00 AM
SITE_LOCATION
13550 W HWY 12
P_LOCATION
99
P_DISTRICT
004
QC Status
Approved
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EHD - Public
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INVOICE - <br /> WEIGNMASTER CERTIFICATE <br /> THIS IS TO CERTIFY that the following described commodity <br /> was weighed,measured,or counted by a weighmaster,whose <br /> signature is on this certificate,who is a recognized authority of 4 2 4;/�� /ham r <br /> 0'V rli.2 <br /> acDicuracy, prescribed Chapter 7(commencing with Section <br /> 12700)of Division 5 of the <br /> California Business antl Professions C E M E X <br /> Code,administered by the Division of Measurement Standards <br /> of the California Department of Food and Agriculture. <br /> NOTE: <br /> Excess water is detrimental to concrete quality. Increased water in concrete mix reduces strength and durability and increases shrinkage. <br /> Buyer accepts responsibility for water added on job site,which exceeds accepted water/cement ratio and workability specifications. <br /> Plant: Begin Loading: To Job: Arrive Job: Start Unload: Finish Unload: Leave Job: Return Plant: <br /> } <br /> Total A roount for This Ticket Not Including Standby Charges: <br /> Cash Check#/Auth Code: Signature of Driver Receiving Cas0 Cash Received: „ Total COD Order Amount to Collect <br /> Check Without Standby Charges: <br /> Charge <br /> Cuatorger Cole Customer Name: Customer Job Number: Order.Cod§_/Date: <br /> Project Code: Project Name: Deputy Weighm�ster: Order P.O.Number; <br /> Tpket,Date; DeliveryAgdress: Map Page: <br /> Delivery Instructions: Ticket Number: <br /> Due Op Job:, Slump: Load:, Truck Number Driver Number: Dni of Name: End Use: <br /> LOAD CUMULATIVE ORDERED <br /> QUANTITY QUAMATERIAL CODE PRODUCTION DESCRIPTION UOM UNIT PRICE AMOUNT <br /> NTITY QUANTITY <br /> i <br /> Water Added Curb Line Crossed At Owner's SUB TOTAL <br /> IN GALLONS. Agent's Request: n <br /> AUTHORIZED SIGNATURE <br /> TAX <br /> Print Name: Date - .. <br /> Signature above signifies receipt and acceptance of the listed materials and acknowledge- TOTAL <br /> INITIALS INITIALS Ment of and agreement to the CEMEX terms and conditions. <br /> BATCH DATA: 42 <br /> 1 <br /> i)c?Cl is zE., N1 i.} Code 1.'1,P I l c 4,9 E <br /> r-• s r r �. c_ .c i <br /> i <br /> j 3 1 3:_ i:. I! IL'I S s 4 0:3 4�•� C:�.-7._;^ ,� I.'c s 4 i .i <br /> Material design Qty Reqqu��ired Batched liar % 'tar y Moisture Actual Wat Tot.Wat Trio <br /> NSCOM 2175.00 1 b 4558.75 lb x+51•'_0.00 lb -3-&75 -0.85% 4.80% A 24.80 gl 24.80 <br /> CEMENT 953,00 lb !936.00 lb 1930.0@ 1b "-6.00 -0.31% <br /> WATER 60.00 gal 82.049 gal 83.00 gal _. Ai 0.022% K.N gl K,A..�;.-"00 gi <br /> ctrJai Nue Batches: 1 Kani_41 14:28:06 <br /> Load Total: 7143 lb Design 0.517 Water!Ceoent4.466 A Desigrn 120.@ gl Acteal. 107 9 To Add: 12.2 gl <br /> ,tupp., 7.00 i7 g Adjlst Water, &0 gl I load Trio Water:-6.0 g1 ! t <br /> t <br /> 80UNIVERSAL Rev 4/12 <br />
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