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ROBERTSON'S Phone 800/834-7557 San Diego 800!870-1220 THIS IS NOT A TICKET NO CONTROL L NUMBER 2*, ANT TX CD MAP PAGE TICKET NO. CUSTOMER PO ;JOB 04I LOT or DELIVERY ADDRESS I .NS'RJOTTONS DATE CUSTOMER NO SOLD TO nmE PrPED TAXI< DRNER °POP NO METER REZING _ ,c) SLUMP TRUCK LIC NO DRUM REVS' START POUR FINISH POUR FAYE JOB WEIGHMASTER CERTIFICATE THIS IS TO CERTIFY rat the to owing describe,: commodity was weighed. measured or counted by a weignmaster. ribose signature eon this celibate urho Is a recognized authority of accuracy as prescribed by Chaoter 7 (commenong with Section 12700) of Drvisicb S of :he Calitomia Bru.vness and Prcfessbns Code. administered by the Division of Measuremeri Standards of he CaYonn a Deparrert of Fooc and Agriculture ROBERTSON'S WEIGHHASTER 7:5 0-0 (1) NJ 0 NJ Dana Afonskaia, Registered Environmental Health Specialist PHOTO #2 Cement truck receipt. Used remaining cement from WP0041492. OZOZ/ZZ/ZI :@TeC1 Site Address: 11293 Manthey Rd, Lathrop E9ZT1700dM GI PJ03@2:1 *1 RIVEREVE • WO td) ST. 02 MORINO VALLI) 14250041215 Paw Row 03 FOUNDS 8353 ALMA= S1 r 5 %TRION-1.05946MS . 33651 3419 51 P76 NORM- 20i E COMAERCIAL ST C? %WARM. 310 N 10AT.513( ST wwwirmca corn OPEN 7 DAYS R)*(1MA • 13732510VMM 915 LAKE FOREST • 25931 TOWN SEM% DR 929 Et WA • 215 CORES IR 05 MONA -2470 POLK* BLVD *19 A/MARTO. 12203 HBO RD. no coon58.1505F36.ICST go MESA - 9949 S. St065 PIT .5.44.11441CAPS71443 • MI t MYRA) *6 RUT.%) .1949.70 1675 STATE ST. a sAgsaeflt .116 Fol*CON CT 131 HESPERIA • 9N1 C AVE NI .4CUAVI- 110 E. Ite 58 *54 Y-2ie10M10R VD *1 8949134*. 4.52W WS ESTRADA PO 071 91411*5 , 16961 011615115111: DR WEST *32 CARROLL WON. 100 No 1035NTAN AD 442 tICTDRIALLE • 16952R ID ST 955 MARC -S011845011 OTV • ?)150 WATSON RD ott II3 hOLLYWOCC •• 13132 RAr,e9 ST OD 1AiRAVAR -5952 EAsTsATE DR 043 BAKER -55500 OMER MD *56 0TI0335.010/168004 .9 ARROWHEAD 3750 Ray is 923 PARANOID' - TM E ROSECAMS GE 034 LlaRti - 35555 we II *44 FT IRWIN • 58625 FORT WO:RD 037 FRiNCR CAP 10503 *1,,VA4019 *10 SAUTE S9R86,5 - 12311 '.511E5755109E 544 124 RIALTO - IC 1 4 9106 650 13 96 135411)91 • 129.25 GAR5191 DR .45 (*APSE:AV- MI E. 14414 SI 058 TRACY • 37.03S 6910 PDX CABAZON • 13491ARACti MAX #25 CARDOIA • 301 Mt ROSEDIVLSWE .16 ESG010100 - 1313$9,01311 WAY 016 C11.-(11) - 7900 MOSS 4vE. 059 BOARSRLD - COMM SCON 12 35/. outwork°. 1365 17 91451 076 *HMSO) PAPS. 72460 VANES RD. *37 MO , 38110RnocANy0H AD. 447 PORT OF UM EfX.H. 1502W RIR 6 s: 968 SKR/OEM - MIMS MON 473 NIN40.1/F • 1)531 LIVE 058 1493 .21 HURRETA • 261935041S AVE 48 ROGICREST • 2157 919154111* RD. .49 RI Oaf?. MX W LOSAIGELESM ILLIPLE LOCADOIG IN Wall 736513458 -142155 UNCOLN AVE 925 OTAY VESA -061 AIRWAY RD o39 RI140,11-£ -31790 751145T FAS 052 CHULA ASIA • 2275 4413610 HON) MULTIPLE 510581116 IN ROW • DAM 9C1 Job-site Cylinder Test: Yes TIME ON JOB Mfi. CHECK it STAND BY MIN CHECK II RA'E OF X S PER MIN GASH CI 410(.8;1 BY NEM)* CHARGE 4 min. per yd. unloading lime allowed. Additional unloading time charged at current hourly truck rate 45101.5NT BY .J.NcrifT n ANT fiertal itifer addcl bible mhzate Alf 'eta its sant. Ari *ter added exceeding te kip nate( is al obtemer's cum risk. Signature eertilying under penally of perjury that the information contained in this written time record is true and correct EWA SIGNATURE TERMS AND CONDITIONS OF SALE Customer agrees Mat the described matenal has been chosen solely by Customer without Robertson s direction. or review any plans or specifications relating to the pro/ebbs) where Ire material is to be used Customer further agrees that d, Mai' be sot* responsible la* the deirery location. and discharge'placernent of meter a' on the yob site including the on-site direction 01 Robensons vehicles to the designated location Customer s renew and apGrOva the desabed 11a19'31 shall be evidenced by Customer's signature and' placement of the described material on the iob site. In consideratoncf the above. Customer ic'easrn and agrees to defend. indemrify and hold Robertson s and ts emptyees and agents narrnless from any and all losses damages liabines, costs and clams asserted by Customer cr any third pany sing from 01 material ben5 InaPOradnate incorpaLote. improper or inconsistent with Ons anz specifications. ceaegroandshesceccndeosssnUnebedweeeeenateriatsed.mlutiere movement of Robertson's vettbJes upon or about the delivery location Solely to the extol Customer tails to timely pay for the descrbed 015157 Vs. n the event Robertson's miens the services of an attorney. Customer woes to pay such reasonable attorney's fees glared by Robertson's in !utterance of such collection efforts Robertscris and Customer chsciarm attorneys tees arising horn any other context ustomer agrees to pay a hme prcedderenfial of I % per month on any arnO.PISCrAed lc Rtertson s la• mere than litrly ;30) days. Color Discialmer Due to regulates andrcr bconsistercy rrater.als Nansens snot respenstie for the resuns of arty concrete where the oolong agent has been added at ire request of the customer. Otter at our plant or on the job site LO Q1Y CUM ()TY ORD 01Y PROD CODE MIX AND COMMODITY UOM UNIT PR AMT BY DEP LrY JOT *EVERSION • • :.,23.5 V.73 FO=OUNCES (11.METERS3 93.611055339 L.LITORS Mt.,.PLULITEFS. CI CONCRETE DELIVERY TICKET AGREED TO AND RECEIVED BY CUSTOMER PO BOX 3600 CORONA CA 92878-3600 TAX PREVIOUS BALANCE SUB TOTAL STAND BY CHARGE TOTAL Water added on job at Customer's request: gals to Full Ld. gals to 2/3 Ld, gals to 1/3 Ld. ADJ. Meter