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WP0039868
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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WP0039868
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Entry Properties
Last modified
11/19/2024 3:48:24 PM
Creation date
9/6/2019 3:31:53 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
WP0039868
PE
4380
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 0 2-6 i 2 <br /> accuracy,as prescribed by Chapter 7(commencing with Section <br /> 12700)of Division 5 of the California Business and Professions ZZC G M G X <br /> Code,administered by the Division of Measurement Standards <br /> of the California Department of Food and Agriculture. <br /> NOTE, Excess water is detrimental to concrete quality. Increased water in concrete mix reduces strength and durability and increases shrinkage. <br /> Buver 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 /> Total Amount for This Ticket Not Including Standby Charges: <br /> Cash Check H/Auth Code: Signature of Driver ReEeiving Cash:' Cash Received: Total COD Order Amount to Collect <br /> Check Without Standby Charges: <br /> Charge <br /> CustoriW Cope Customer Name. Customer Job Number: Order-Cocig/Date: <br /> .... <br /> Project ode: Project Name: Deputy Wei9hm ter: <br /> Order PO.Number: , <br /> TiCkei,,Date; ., _ Delivery Address: Map Page: <br /> Delivery Instructions: Ticket Number: <br /> .r <br /> Due On Job: Slump! Load: Truck,Number: Driver Number: Driver Name: End Use: ! ; <br /> LOAD CUMULATIVE ORDERED <br /> QUANTITY QUAQUANTITY MATERIAL CODE PRODUCTION DESCRIPTION UOM UNIT PRICE AMOUNT <br /> NTITY <br /> Water Added Curb Line Crossed At Owner's n SUB TOTAL <br /> IN GALLONS: Agent's Request <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: U'� <br /> I. i:_Jc�C{ :?:t.xt.' tl]. ?• l,t7tlF' ...'1s p I7.C.k. °::': 42 <br /> 241iS1 - <br /> Sa r r r e- �c� cc•� f <br /> Material Design aty Reqaired Batched Var % Var y Moisture Acti'al Wat Tat.Wat Trio <br /> NSCOM 2175.00 lb 4558.;t lb 4520.00 lb -38.75 -0,85% 4.80% A 24.80 g 1 24.80 <br /> EMENT 968.00 lb 1935.00 lb 19-30.0 1b 6,00 -0,31% <br /> WATEk60,00 a l 82.°9 gal 83.0.0 gal .0i P.0c^% &I N g l 83=041;,�y'.-ir,00 g4' <br /> Actual }due Batches: 1 ManLal 14:28:06 <br /> Load Total: 7143 lb Design 0.517 Water!Ceaent .466 A Desi. ,n 120.0 gl Actual. 10 ggl To Add: 112.2 gl <br /> ='eap. 7.00 in # Ad.j'�st Water: 0,0 gl ! Load` Trim Water.--- gl 1 C D <br /> i <br /> 80UNIVERSAL Rev 4/12 <br />
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