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California Rock & Ready Mix <br />1200 L. Turner Rd. • Lodi, CA 95240 <br /> 129779 <br />(209) 368-5351 • Fax (209) 368-58,24 <br />NAME i t I • 55 <br />DATE S 4.- <br />&Cc" Cii'l <br />ADDRESS <br /> <br />JOB SITE Leve; k)AM 0 <br />TRJ NO, t <br />TIME , • , <br />OUT I • 'c• <br />PHONE <br />AM <br />PM 0 <br />AMOUNT <br />CAUTION <br />Fleshly mixe C3.5d CVIIPA-11. csir <br />ncceke %Totga <br />poNalltte and wa4, exposed eT :tees rttornotly 'BNB water. lt <br />any :ament MiXtUreS gel 'Mk° °AS. <br />tirlSrl Immediately and tepee <br />with water- and_got RronV otemion. KEEF OUT 0 <br />OF CHILDREN. <br />Viin,21 <br />'I <br />IN Iv. t," 1 kv• toiC 'obi <br />IrargittImItr, SUIVA23 <br />ivATN: Fa,* <br />tt4t, N,It'A <br />.1 Ito equiprne <br />II II,0 ogti.p•red. 15 0500 <br /> map than 1•••c• hod, Iite d <br />chow@ . val teema• sda."049" Ina Ine am. matagmaa nea <br />corMdedelen T. Weds to TM ass meIW. dIenia md Men ,,,Otignes ta 40•44.040111111411111101111WOM WM 4011. <br />II. Ubill....0.0.0.6%.. IMA im Ma Insomdee mid vele <br />end Wei he NIS <br />Wand VA nem sae Tootame sale sad <br />awes/MP Maude MI naloonalbaht Pa OW leased <br />The woes estop*peseta Indenviial and sasetattise <br />pens* sasInittram MN leas oi damage. to Ma serson ot <br />poneaude Maned ef Wag In Ns *AVM . In Tna event el <br />Cattlerwts P00% I Ready VAa. Ths teases twee' to comps snat slI Was ot the <br /> Side <Ave <br />awns tat maponsowni log ere, then. <br /> cpd.r.elAr, STN3 aS <br />poeseasIon <br />tot any dama <br />We aro not tesponsaale <br />ge encountered <br />Matedata customer hat ortiMed Customer sdh pay a <br />What dUMtB Cd slotaln In the ales the cust0Met <br />Francisco Garcia Ruiz, Environmental Health Asst. Page 2 of 3 <br />Site Address: 10696 Hwy 12, Lodi CA 95240 <br /> <br />Record ID: WP0041776 <br />Date: 4/22/2021 <br />PHOTO # 2 New Well. Grouted from 200 ft using 10.3 sand cement.