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WP0042406
EnvironmentalHealth
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SHELTON
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28786
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4200/4300 - Liquid Waste/Water Well Permits
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WP0042406
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Entry Properties
Last modified
12/9/2022 3:22:06 PM
Creation date
9/14/2022 4:32:20 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
WP0042406
PE
4369
STREET_NUMBER
28786
Direction
E
STREET_NAME
SHELTON
STREET_TYPE
RD
City
LINDEN
Zip
95236-
APN
09334013
ENTERED_DATE
8/9/2021 12:00:00 AM
SITE_LOCATION
28786 E SHELTON RD
P_LOCATION
99
P_DISTRICT
004
QC Status
Approved
Scanner
SJGOV\lsauers
Supplemental fields
CYEAR
2021
Tags
EHD - Public
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WEIGHMASTER 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 CONCRETE PRODUCTS INC. <br /> of accuracy,as prescribed by Chapter 7(commencing with <br /> Section 12700)of Division 5 of the California Business and 1900 Roosevelt Avenue, Escalon, CA 95320 <br /> Professions Code,administered by the Division of Measurement P <br /> �f <br /> Standards of the California department of Food and Agriculture. 209-838-1 448 <br /> WEIGHMASTER SIGNATURE INVOICE/TICKET NO. <br /> NOTICE: MY SIGNATURE BELOW INDICATES THAT I ACCEPT THE TERMS AND CONDITIONS OF THIS DELIVERY TICKET, WAITING TIME <br /> INCLUDING THE TERMS AND CONDITIONS ON THE REVERSE.WE MAKE DELIVERIES INSIDE CURB LINES AND ON <br /> LOTS OR PROPERTY AT CUSTOMER'S RISK ONLY AND ACCEPT NO RESPONSIBILITY WHATSOEVER FOR ANY DAMAGES $ per hr.unloading charge. <br /> RESULTING FROM SUCH DELIVERIES.CUSTOMER SHALL INDEMNIFY,HOLD HARMLESS&DEFEND P&L CONCRETE LEAVE PLANT <br /> PRODUCTS,INC.FOR,FROM&AGAINST ALL CLAIMS FOR DAMAGES OR PERSONAL INJURY.EXPENSE OF REMOVING <br /> MIRED TRUCK PAYABLE BY CUSTOMER.WE ARE NOT RESPONSIBLE FOR THE STRENGTH,SLUMP,OR QUALITY OF <br /> ANY CONCRETE TO WHICH WATER OR ANY OTHER MATERIAL HAS BEEN ADDED AT THE BUYER'S REQUEST.WE DO ARRIVE JOB <br /> NOT GUARANTEE THE COLOR OF THE CONCRETE.WE HAVE NO CONTROL OVER THE PLACING,FINISHING OR <br /> CURING OF CONCRETE AND DO NOT GUARANTEE THE FINISHED WORK IN WHICH IT IS USED,INCLUDING CRACKING. <br /> CONCRETE IS A PERISHABLE COMMODITY AND BECOMES THE PROPERTY OF THE PURCHASER UPON LEAVING THE LEAVE JOB <br /> PLANT.ANY CHANGES OR CANCELLATIONS OF ORIGINAL INSTRUCTIONS MUST BE TELEPHONED TO OFFICE BEFORE <br /> LOADING STARTS.CUSTOMER IS RESPONSIBLE FOR PROVIDING A SUITABLE PLACE,ON CUSTOMER'S PROPERTY, <br /> FOR DRIVERS TO WASH CHUTES AS NECESSARY.ANY CLEANUP COST OF CUSTOMER-PROVIDED WASHOUT SITE ARRIVE PLANT <br /> OR REMOVAL OF TRACKED-MUD FROM STREETS AND ROADS WILL BE BILLED TO CUSTOMER. <br /> SEE TERMS AND CONDITIONS ON REVERSE SIDE.READ FRONT AND REVERSE CAREFIULLY <br /> WATER ADDED CYLINDERS TAKEN <br /> BY: CUSTOMER SIGNATURE ATCUSTOMER'SREQUEST GALLONS ❑YES 0 N <br /> CUSTOMER ID P.O.NUMBER LOAD NUMBER JOB NUMBER TIME DATE TICKET <br /> SOLD TO DELIVER TO DRIVER <br /> TERMS <br /> QUANTITY QUANTITY PRODUCT PRODUCT UNIT OF UNIT EXTENDED <br /> THIS LOAD DELIVERED CODE DESCRIPTION MEASURE PRICE PRICE <br /> TRUCK PLANT SLUMP DUE AT JOB USE OF CONCRETE <br /> WAITING TIME <br /> SUB TOTAL <br /> SPECIAL INSTRUCTIONS ,i 1 b. 00 1 ;014) Pty l .,f4Ni.il ICI 14'3 TAX <br /> TOTAL <br /> ,t+131i1-`k78_31 t *E_SC—l3EL._L0TA, R. SHEI_JON, GRAND TOTAL <br /> R, HAVERL-Y, GATE AT THE TOP_ <br /> INVOICE/TICKET NO. <br /> Tr lick 1)r-.iVer t_15er Di -zp; Ticket NiUm Ticket ID Tilne Daae <br /> ESE.IE PHTL.IP +x.:768 12: 14 3,'21'22 <br /> L.o=i d '. i z Mi )( Code R e It1.1r I-)ed Pt Mix Age Seq L-oad ID <br /> 6. 017 :gid SANI700103 D 45336 <br /> Material Design Qty Reqgu�ired Batched % Var % Moisture Actual Wat <br /> SAND 1101 285@ 16 18126 lb 18140 lb 0.08% 6100% M 123 g1 <br /> CEMENT %8.0 1b 5809.0 lb 5810.0 lb 0.03% <br /> WATER 40.00 gl 135.05 g1 135.00 91 0.04% 135.00 g1 <br /> Actual Nur Batches: 1 <br /> Load Total: -^507,7 lb Design 0.345 Water/Cement 0.371 A Desi n 240.0 g1 Actual 258.0 gl To Add: 0.0 gl <br /> �ump: 5.00 in # Water, gl in Truck: 0.0 Adjust Water: 0.0 g1 ! Load Trim Water: 2.0 gl/ yd Note: Manual feed oc <br /> tual W/C Ratio: 0.371 Actual Water: 258 gl Batched Cemen?: 5810 lb Allowable Water: 0 lb <br />
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