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California Flock & Ready Mix <br /> 1200 E. Turner Rd. • Lodi, CA 95240 144484 <br /> V�+J r< (209) 368-5351 • Fax (209) 368-5824 <br /> NAME i l- �/� C.' DATE 2z ?/✓ L <br /> f, n ell' ADDRESS �� �/�� �� i�l/! � � PHONE 5 YG <br /> JOB SITE W �� <br /> TIME AM ❑ TIME AM ❑ TRUCK NO. TRAILER NO. <br /> OUT �Z'�Z t -2- PM ❑ IN PM ❑ <br /> CITY. DESCRIPTION PRICE AMOUNT <br /> Su C tL <br /> EQUIPMENT RENTED F <br /> CAUTION HAND TROWEL <br /> Freshly mixed cement, mortar, HAND FLOAT <br /> concrete or grout may cause skin <br /> ` injury. Avoid contact with skin EDGER <br /> where possible and wash exposed TRAILER <br /> !!! skin areas promptly with water. If <br /> any cement mixtures get Into eyes, _. <br /> rinse immediately and repeatedly <br /> A,�.b0� attention. KEEFOUT OF medical REACH Apar Code 05593D <br /> V, OF CHILDREN. Transaction ID; 582186717199152 <br /> SALES & RENTAL AGF <br /> pprvd; Online htchP: 000219•If the equipment is not properly cleaned after use,lessee agrees to pay a CVV2 Code; MpiCH M <br /> 9 If the equipment is used more than two hours,fee of S25 per hour on <br /> charged. <br /> -The lessee acknowledges that the ahove equipment has been delivered <br /> consideration he agrees to pay the rental charge and sign this agreement. <br /> mortgage the leased equipment and to return the same in as good conditioi I agree to osv above total amount <br /> according to card ias+er agreement <br /> -The lessee acknowledges that he has inspected said trailer,trailer hitch <br /> and that he has found the trailer and hook-up safe and secure and the (Merchant agreement if credit voucher) <br /> agreeing to assume all responsibility for said leased equipment while it Is it <br /> -The lessee further agrees to indemnify and saveCalifornia Rock&I <br /> pense arising from any injury or damage to his person or property that mai <br /> proximate result of its being in his custody.In the event of any accident <br /> California Rock&Ready Mix. �------------------------------ <br /> -The lessee agrees to comply with all laws of the State covering the use ---- <br /> sume all responsibility for fire, theft, confiscation, and all citations and <br /> possession. Merchant Copy <br /> We are not responsible for any damage encountered while C <br /> materials customer has ordered.Customer will pay all tow c THANK YOU <br /> while dumping or working in the area the customer requested. PLEASE COME AGAIN <br /> SIGNATURE <br /> X <br />