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WP0041747
Environmental Health - Public
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4200/4300 - Liquid Waste/Water Well Permits
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WP0041747
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Last modified
8/11/2021 4:48:54 PM
Creation date
7/14/2021 9:14:56 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
WP0041747
PE
4369
STREET_NUMBER
133
Direction
W
STREET_NAME
JAHANT
STREET_TYPE
RD
City
ACAMPO
Zip
95220-
APN
00310027
ENTERED_DATE
3/1/2021 12:00:00 AM
SITE_LOCATION
133 W JAHANT RD
P_LOCATION
99
P_DISTRICT
004
QC Status
Approved
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SJGOV\tsok
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EHD - Public
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Address: 133 W. Jahant Rd, Acampo ID: WP0041747 <br /> t ilii F � <br /> _ ea } <br /> �✓/\ a_ •ear - I_t1111r VH Jy�fjU r �:.. ... �_ <br /> (209)368-5351 • Fax(209)368-5824 132545 y •, <br /> NAME I U IZ L%✓IiU.S'7 L t <br /> 2 Z DATE <br /> ADDRESS�I ) (4) Lr Ct rL T <br /> PHONE5 Y S— 11 <br /> JOB SITE 6t1vl 0 <br /> TIMEA11TIME <br /> OUT 1116"3, ❑ TRUCK NO. T AILE <br /> PMM 11 13 IN P <br /> QTY. M n DESCRIPTION <br /> C G- <br /> J ('4 13 - IOL IfUa11A ROOM.PJU REM,mix <br /> 12.0 C ttit RD <br /> L(01 IlaaA 9a2q <br /> S' r <br /> tkrchant ID:Rgg9 <br /> I—a:eka3 Sr.ara u:g0is <br /> R<f n:uun <br /> t Phone Order <br /> XXXXXXXXXxYX813� <br /> EQUIPMENT RENTED PPI I%SIERC�QD Entry hem:Hamel <br /> CAUTIO HANDTROWEL <br /> Freshly mixed cement, mortar, HAND FLOAT Total• $ 503.37 <br /> concrete or grout may cause skin <br /> injury. Avoid contact with skin EDGER <br /> 1 r - where possible and wash exposed TRAILER <br /> skin w 11 reas promptly with water. II <br /> any cement mixtures get into eyes, <br /> rinse Immediate y and rPepeatedly 0I/91/21 81,33:43 <br /> _ atltentionef KEEP OUT OFt REACH Im a;1308882 .Paar Code:081550E <br /> OF CHILDREN. <br /> Irawtion 10;ON 10M1 <br /> SALES&RENTAL AGRE Hoclvd,0nlint B j:W M <br /> •II the equlpmem Is not property,cleaned after usa,ja_.agrees to Pay a S50 CVC2 Cade;MATCH h <br /> • <br /> If the an ivment,s used more than Iwo hours,fee of$25 per hour on wee <br /> charged. <br /> •The lesaee eckn--edges Ina,the obeys equipment has Iwan d.ltvared to <br /> consideration he agrees to pay the rental charge and sign Ina agreement.The <br /> mortgage the leased aquoment and to return the same in es good condhlon as 1 awe.to oa.above total mount <br /> •The lessee aeknowlongee that he has impacted said ball.r. <br /> Yeller hitch and srdlns to cord t r l saaernt <br /> and that he has found the bailer and hookup sale and secure.6 the othe ace swe <br /> ., agreeing to assume all resteensibibly for said leased equlpmam while it is In his (11—merit awaearnt f c, d,t—1-1 <br /> •The losses further agrees to indemnity and save C.aliforola Rock&Rear <br /> {: pence arising from any Injury or damage to his person or property Nat may oca <br /> proximate reaull of Its Icing In his custody.In the event of any accident,the <br /> _=•s..•,:- •r C llfornla Rock&Ready Mla. y <br /> _ •The leasee agrees to comply with all laws of the State covering the use of Ira X-__-•_�-_----- -•�-_�-.-...- <br /> _ r me aNon. <br /> responslMlity for lire,(haft,confiscation,erant!.11eru. <br /> ctaaena and P <br /> a `- .ir` possessi <br /> F We are not responsible for any damage encountered while Cattle 11-1 m 1 Cuur <br /> materials customer has ordered.Customer will pay all tow charge <br /> whiledum In or workingIn the area the customer requested. TI"YOU <br /> t E PLEASE CONE AGAIN <br /> v <br /> Naseem Ahmed, Registered Environmental Health Specialist <br />
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