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WP0036460
Environmental Health - Public
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4200/4300 - Liquid Waste/Water Well Permits
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WP0036460
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Entry Properties
Last modified
7/24/2018 10:32:21 AM
Creation date
7/24/2018 9:30:20 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
WP0036460
PE
4366
STREET_NUMBER
5314
Direction
W
STREET_NAME
G
STREET_TYPE
ST
City
TRACY
Zip
95304
APN
25006009
ENTERED_DATE
1/30/2017 12:00:00 AM
SITE_LOCATION
5314 W G ST
P_LOCATION
99
P_DISTRICT
005
QC Status
Approved
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AMeuangkhoth
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EHD - Public
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1 C:�lL VERA S <br />H: LBERGCEMENTGroup <br />Calaveras Materials Inc. <br />7673 I'I. Ingram Avenue <br />Fresno, CA 93711-5838 <br />Phone 559-277-7060 <br />Toll Free 800-726-5615 <br />Delivery Tag <br />�G.. Weighmaster Certificate <br />MnivTECi I. _ <br />1945 LO- Tl-lROP ._.. <br />CUSTOMER COPY 2 <br />Load Leave Plant Arrive Job Start Pour End Pour Leave Job Arrive Plant <br />Water Added on Job at Customer <br />Customer's Request Gallons Signature x <br />WEIGH MASTER CERTIFICATE: THIS IS TO CERTIFY that the following described commodity was weighed, measured, or counted by a weightmaster, whose <br />signature is on this certificate, who is a recognized authority of accuracy, as prescribed by Chapter 7 (commencing with Section 12700) of Division 5 of the <br />California Business and Professions Code, administered by the Division of Measurement Standards of the California Department of Food and Agriculture. <br />6bfNTRCLra - .., <br />-4F A 6 4 3 Q <br />Plant Ticket No. Order No. Customer No. Sold To: Date <br />'Of ..DFN 11Tn"f E. C01\11.11'Pt.1171 TON <br />Delivery Address Zone Driver <br />Special Instructions Project No. <br />Special Instructions Job Number <br />Truck No. Lll. Proj <br />oad Size Mix Code Slump 90 Air %Caect Name: <br />Load Cumulative Ordered Unit of Product Product Unit Amount <br />Quantity Quantity Quantity Measure Code Description Price <br />_ 1.300r o , 3 Sr; SAND <br />CnCARBI) I. Cf�RP/EtVV I � RNID <br />CALAVERAS MATERIALS INC. ASSUMES NO CERTIFICATE OF COMPLIANCE: WE CERTIFY that the <br />RESPONSIBILITY FOR DAMAGE INCURRED IN portland cement, chemical and mineral admixtures contained in <br />DELIVERING MATERIALS INSIDE THE CURB LINE. the material described below are brands stated and comply with <br />specifications: <br />CALAVERAS MATERIALS INC. CEMENT BRAND: Sub total <br />TYPE: II MILL LOCATION: — Tax <br />CHEMICAL ADMIX BRAND: TYPE: <br />MANUFACTURER: <br />By MINERAL ADMIX MANUFACTURER: <br />CLASS: <br />' <br />N0. �F <br />DO NOT USE FOR TICKET NO. <br />FORM # WC (Rev. 5106) X288327 <br />Total <br />6bfNTRCLra - .., <br />-4F A 6 4 3 Q <br />Plant Ticket No. Order No. Customer No. Sold To: Date <br />'Of ..DFN 11Tn"f E. C01\11.11'Pt.1171 TON <br />Delivery Address Zone Driver <br />Special Instructions Project No. <br />Special Instructions Job Number <br />Truck No. Lll. Proj <br />oad Size Mix Code Slump 90 Air %Caect Name: <br />Load Cumulative Ordered Unit of Product Product Unit Amount <br />Quantity Quantity Quantity Measure Code Description Price <br />_ 1.300r o , 3 Sr; SAND <br />CnCARBI) I. Cf�RP/EtVV I � RNID <br />CALAVERAS MATERIALS INC. ASSUMES NO CERTIFICATE OF COMPLIANCE: WE CERTIFY that the <br />RESPONSIBILITY FOR DAMAGE INCURRED IN portland cement, chemical and mineral admixtures contained in <br />DELIVERING MATERIALS INSIDE THE CURB LINE. the material described below are brands stated and comply with <br />specifications: <br />CALAVERAS MATERIALS INC. CEMENT BRAND: Sub total <br />TYPE: II MILL LOCATION: — Tax <br />CHEMICAL ADMIX BRAND: TYPE: <br />MANUFACTURER: <br />By MINERAL ADMIX MANUFACTURER: <br />CLASS: <br />' <br />N0. �F <br />DO NOT USE FOR TICKET NO. <br />FORM # WC (Rev. 5106) X288327 <br />
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