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Site Address: 23685 N Tretheway Rd, Acampo CA 95220 Record ID: WP0044139 <br /> Date: 5/18/2023 <br /> PHOTO #2 New well. Woll rolitod from 100 ft usin 10.3 sack sand cement. <br /> - OUE51E RE 11CKibQO6 <br /> EEHP NU ' <br /> LOAD <br /> 0110'1N 18 <br /> O,• ,OB AY P�µT <br /> VE <br /> Q GROV6esD °33.6ag9 OUR LEA STRUCK <br /> R <br /> P. DFESCF�20 gI.65Tj 120 CA o5 t POUR END p PREVIOU necL <br /> N►FEs,_►� Di Fac h 16,601p16 StOpRµ1VE100 STAR T BLOCK VERIE1Ep7 C <br /> r K �" <br /> Pn MOU PEsou LD & ADD <br /> R <br /> P 0 gOX LEAVE PUtNt <br /> ,P..,v�v.knifenver nom PIANT ID V,I AY <br /> so et Flr$tDRNER O6 PROIECr NAME ADoftE551LOCp1RTH TRET f1E <br /> y;Et4 0 I pROlEC1 4 <br /> 0. DELIVERY 236g5 N <br /> —034I Cu5ToMERP. • VALLEYx U�pNS <br /> 550341824 / ORUMREVOL <br /> -- COSTOMER ACR 10 It, PQ 378044 AOpM <br /> To: TOTAL <br /> solo ILUN� ENDING <br /> VA1lEY OR BEGINNING wouOt <br /> EXT <br /> rn Unit <br /> oras: <br /> UOM 192 '0 A0 Oy <br /> LL "DELIVERY INSTRUCn d <br /> 110DIT10 cc <br /> pREPAID Ptodu¢0�°tlp AND SLURRY <br /> ,� C• <br /> �Y0 pV,d ProdudCade FU�.L S RCHARGE SORCHAR <br /> G£ <br /> tryls loa" d ctw"T.0 5.00 Sp4 FR£1GRT <br /> pty0, G.0'J 554015 CEMENT <br /> I. <br /> 00 555Fg <br /> b 00 <br /> SUBTOTAL $97.26 _ <br /> xALES TAX - <br /> S <br /> OVERTIME MINUTES $1,352.26 <br /> INGTIME TICXET TOTAL <br /> t STANDBY AND UNLOAD LTINIE FEE $1,352.26 <br /> ED SLUMP b disPatchatthecurrent ADDITIONP GRAN 'TOTAL <br /> ESTIMATED Rlbeassessed V BveISlminutespet WE$SITE <br /> WATER ADDED/ SLUMP Eacea uUck 7mev p1T10NS ON <br /> GAL SLUMP rate per minute f°r orders exceeding &TERMS ANO CON <br /> •I� _ Full Load: GAL SLUMP cuhlc Vard. WATER ADDED, <br /> -r- 2/3 Load: ACKNOWLEWEMENr Of RECEIPT, <br /> •w GAL me'. <br /> V, 1/3 Load: REQUES7E0 SLUMP Printed Na Im OSed a5 a <br /> 1,&N <br /> D SLUMP ration from liahllity P <br /> DESIGN 6,00 I�gfgnamre. and save harmless KD d River pp ADoMONALRELf ASE <br /> 4 00 RELEASE:Contrador or Owners agree to indemnlfY <br /> - NCRETE,AS PIACED resuR of any damage causedto the property I others as a result of such delivery• <br /> USE OF CO INFORMATION:SEE W W WKNIFERIVER.COM/NCA FOR PROP 65INE0 W WtN•P65W ARNINGS.CA.GOV <br /> 8 Printed Name. <br /> r1' p/TEMp/cL5 Weighmaster Certificate <br /> AiR/SLUM Signature. <br /> TESTED By '-- odity was weighed, measured of counted by a •.+eighmase <br /> •r described comm of accuracy, as prescribed by Chapter <br /> _ following is a recognized authority <br /> CEP e`is that <br /> ather°POO fora Div sh on rhe California Business and Professional Code, administered by <br /> 5 of artmenc of Food and Agriculture. <br /> ,atur 1� Srandards cf the Ca!ifornia DeP pe Ut.V <br /> vis ionwofhNeasuren`e°t <br /> Ogen Disp Ticket NUM Ticket ID Time para <br /> 1693618 41',1: ll . , <br /> / u <br /> Truog1824 Driver <br /> 99506 <br /> 5503 Mix Code <br /> Load siZe� 504 <br /> 6.00 CYD• <br /> Design Ob ReQ <br /> Francisco Garcia Ruiz, Registered Environmental Health Specialist Page 2 of 3 <br />