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WP0044666
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STATEN ISLAND
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4200/4300 - Liquid Waste/Water Well Permits
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WP0044666
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Last modified
6/17/2024 2:15:22 PM
Creation date
3/20/2024 2:22:04 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
WP0044666
PE
4380
STREET_NUMBER
23400
Direction
N
STREET_NAME
STATEN ISLAND
STREET_TYPE
RD
City
THORNTON
Zip
95686-
APN
06902019
ENTERED_DATE
6/28/2023 12:00:00 AM
SITE_LOCATION
23400 N STATEN ISLAND RD
P_LOCATION
99
P_DISTRICT
004
QC Status
Approved
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SJGOV\gmartinez
Tags
EHD - Public
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California Rock & Ready Mix <br /> � e 1200 E. Turner Rd. • Lodi, CA 95240 JS (209) 368-5351 Fax (209) 368-5824 159325 <br /> NAME l t � "T: 1 S DATE It <br /> ADDRESS z `l O + ) C VJ CfpHONE ( 7/L <br /> �\\`\ 7 <br /> JOB SITE C vt✓?— C-i r vJ e <br /> TIME AM ❑ TIME AM ❑ TRUCK NO. TRAILER NO. <br /> OUT PM ❑ IN PM ❑ <br /> QTY. DESCRIPTION PRICE AMOUNT <br /> 3 l u( Z <br /> c <br /> EQUIPMENT RENTED I <br /> CAUTION HAND TROWEL <br /> es y mixed cement, mortar, HAND FLOAT <br /> concrete or grout may cause skin EDGER <br /> injury. Avoid contact with skin <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 /> with water andet prompt medical <br /> attention. KEEFOUT OF REACH <br /> OF CHILDREN. <br /> SALES & RENTAL AGR Non-Cash AdJUStMent <br /> '' •If the equipment is not properly cleaned after use,lessee agrees to pay a 5 <br /> •If the equipment is used more than two hours,fee of S25 per hour on v <br /> charged. TOTAL AMT: USD $1117.68 <br /> •The lessee acknowledges that the above equipment has been delivered <br /> consideration he agrees to pay the rental charge and sign this agreement.l Resp: A PPROU A L 0175 7 D <br /> mortgage the leased equipment and to return the same in as good condition Code: 01757D <br /> •The lessee acknowledges that he has inspected said trailer,trailer hitch a Ref #: 333818006606 <br /> and that he has found the trailer and hook-up sa'i and secure and the c Trans I D: 383338672586972 <br /> agreeing to assume all responsibility for said leased equipment while it is in <br /> •The lessee further agrees to indemnify and saveCafifornia Rock&R <br /> pense arisingfrom any injury or damage to his person or property that may <br /> proximate result of its being in his custody.In the event of any accident, Cardholder acknowledges <br /> California Rock&Ready Mix. re Cel�1]t Of g00ds and <br /> •The lessee agrees to comply with all laws of the State covering the use c Q r 1 1 a l�1 0 of <br /> set s0 rn d <br /> surae all responsibility for fire, theft, confiscation. and all citations and <br /> possession. by }le cardholder' s <br /> We are not responsible for any damage encountered while Ca agreement With issuer. <br /> materials customer has ordered.Customer will pay all tow ch <br /> while dumping or working in the area the customer requested. <br /> GNATURE <br /> Xk-------------------- <br /> MERCHANT COPY <br />
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