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SU0002249
Environmental Health - Public
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EHD Program Facility Records by Street Name
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JACOB BRACK
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18667
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2600 - Land Use Program
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UP-98-08
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SU0002249
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Entry Properties
Last modified
5/7/2020 11:29:08 AM
Creation date
9/6/2019 10:28:06 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2600 - Land Use Program
RECORD_ID
SU0002249
PE
2626
FACILITY_NAME
UP-98-08
STREET_NUMBER
18667
STREET_NAME
JACOB BRACK
STREET_TYPE
RD
City
LODI
APN
01115012
ENTERED_DATE
10/26/2001 12:00:00 AM
SITE_LOCATION
18667 JACOB BRACK RD
P_LOCATION
99
P_DISTRICT
004
QC Status
Approved
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SJGOV\rtan
Supplemental fields
FilePath
\MIGRATIONS\J\JACOB BRACK\18667\UP-98-08\SU0002249\APPL.PDF \MIGRATIONS\J\JACOB BRACK\18667\UP-98-08\SU0002249\CDD OK.PDF \MIGRATIONS\J\JACOB BRACK\18667\UP-98-08\SU0002249\EH COND.PDF \MIGRATIONS\J\JACOB BRACK\18667\UP-98-08\SU0002249\EH PERM.PDF
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EHD - Public
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I WEIGHMASTER CERTIFICATE <br /> THIS IS TO CERTIFY that the following described commodity was weighed.measured,or <br /> counted by a weighmaster,whose signature is on this certificate,who is a nscognized authority a <br /> 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 T <br /> ' Standards of the California Department of Food and Agriculture. <br /> PEARSONS CONCRETE <br /> CAUTION "-71 },' - ' 10284 UNDERW.00D RD., ACAMPO, CA 95220 <br /> TELEPHONE (209) 334-9234 <br /> Freshly mixed cement, mortar, - _ <br /> concrete or grout may cause skin ORDER NO. DATE <br /> injury. Avoid contact with skin where CUSTOMER NAME <br /> possible and wash exposed skin ADDRESS ' ` or-, <br /> areas promptly with water. If any JOB LOCATION LOAD NO. <br /> cement mixtures get into eyes, rinse DRIVER -� ' TRUCK NO. ' _ CU. YDG. <br /> immediately and repeatedly with <br /> water and get prompt medical CONCRETE MIX START TIME <br /> CEMENT ARRIVE JOB /C <br /> attention. ADMIX t <br /> KEEP OUT OF REACH OF CHILDREN. A-1 LEAVE JOB <br /> A-2 ENO TIME <br /> ADMIX 2 <br /> A-3 TOTAL <br /> A-4 FREE <br /> Dear Customer: WATER NET <br /> THIS LOAD SACK WEIGHED AT <br /> GUARANTEED CUBIC a CON- MIX f .M SIMMERHORN <br /> NOTICE: WE MAKE DELIVERIES INSIDE THE CURB LINE TO YIELD YARDS CRETE NO. —�` =GALT,CA. <br /> AT CUSTOMER'S RISK ONLY, AND ACCEPT NO PEARSONSONCRET�wr,YVEIGHMASTER � <br /> RESPONSIBILITY WHATSOEVER FOR -DAMAGES sr = ' <br /> RESULTING. FROM SUCH DELIVERIES. QUANTITY UNITS ;PESCRft'TION UNIT PRICE AMOUNT <br /> The driver of this truck,in requesting the additional signature below,is of the opinion CU YDS CONCRETE <br /> that the size and weight of the truck may possibly cause damages to the premises <br /> andlor adjacent property if the driver places the material in this load where you desire <br /> it.It is our wish to help you.in every way that we can,but in order to do this,the driver <br /> is requesting that you or your representative sign below indicating you have released <br /> the driver and PEARSONS CONCRETE from all responsibilty for any damage that <br /> may occur to the premises and/or adjacent property,buildings,sidewalks,driveways, <br /> curbs,etc. by the delivery of this material. Further,as additional consideration,you <br /> agree to help the driver remove mud from the wheels of the driver's vehicle so that <br /> the driver will not litter the public street, and you agree to indemnity and hold <br /> harmless the driver of this truck and PEARSONS CONCRETE for any and all liabilities MIN. STAND BY TIME <br /> and damages to the premises and/or adjacent property which may be claimed by HOURS RENTAL <br /> anyone to have arisen out of delivery of this order. <br /> 5 MINUTES PER YARD FREE CHARGE C.O.D. <br /> UNLOADING TIME ALLOWED TOTAL <br /> Signature: <br /> TERMS: Net 30 Dara. One and one-ha8 1114%)percent charged on past due acsoaeFi Aar MOSS 616 legal bees <br /> c ` incWmd in collection of allots will be added to this drarge. <br /> «� Received By: <br /> X <br /> TG.B.P.—REV.3J90 <br />
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