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WP0042408
Environmental Health - Public
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EHD Program Facility Records by Street Name
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SHELTON
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28260
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4200/4300 - Liquid Waste/Water Well Permits
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WP0042408
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Last modified
12/10/2021 11:48:56 AM
Creation date
12/10/2021 11:09:22 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
WP0042408
PE
4369
STREET_NUMBER
28260
Direction
E
STREET_NAME
SHELTON
STREET_TYPE
RD
City
LINDEN
Zip
95236-
APN
09332006
ENTERED_DATE
8/10/2021 12:00:00 AM
SITE_LOCATION
28260 E SHELTON RD
P_LOCATION
99
P_DISTRICT
004
QC Status
Approved
Scanner
SJGOV\tsok
Supplemental fields
CYEAR
2021
Tags
EHD - Public
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WEIGHMASTER CERTIFICATE <br />THIS IS TO CERTIFY that the following described commodity <br />was weighed. measured, or counted by a weighmaster, whose <br />signature is on this certificate, who is a recognized authority CONCRETE PRODUCTS INC. <br />of accuracy, as prescribed by Chapter 7 (commencing with 7 <br />Section 12700) of Division 5 of the California Business and 1900 Roosevelt Avenue, Escalon, CA 95320 <br />Professions Code, administered by the Division of MeasurementP 209-838-1448 <br />f p p <br />Standards of the California department of Food and Agriculture. 209-838-1 448 <br />WEI HMA TER SIGNATURE <br />INVOICE/TICKET NO. <br />NOTICE: MY SIGNATURE BELOW INDICATES THAT I ACCEPT THE TERMS AND CONDITIONS OF THIS DELIVERY TICKET, WAITING TIME: <br />INCLUDING THE TERMS AND CONDITIONS ON THE REVERSE. WE MAKE DELIVERIES INSIDE CURB LINES AND ON <br />LOTS OR PROPERTY AT CUSTOMER'S RISK ONLY AND ACCEPT NO RESPONSIBILITY WHATSOEVER FOR ANY DAMAGES $ per hr. unloading charge. <br />RESULTING FROM SUCH DELIVERIES. CUSTOMER SHALL INDEMNIFY, HOLD HARMLESS & DEFEND P & L CONCRETE LEAVE PLANT <br />PRODUCTS, INC. FOR, FROM & AGAINST ALL CLAIMS FOR DAMAGES OR PERSONAL INJURY. EXPENSE OF REMOVING <br />MIRED TRUCK PAYABLE BY CUSTOMER. WE ARE NOT RESPONSIBLE FOR THE STRENGTH, SLUMP, OR QUALITY OF <br />ANY CONCRETE TO WHICH WATER OR ANY OTHER MATERIAL HAS BEEN ADDED AT THE BUYER'S REQUEST. WE DO ARRIVE JOB <br />NOT GUARANTEE THE COLOR OF THE CONCRETE. WE HAVE NO CONTROL OVER THE PLACING, FINISHING OR <br />CURING OF CONCRETE AND DO NOT GUARANTEE THE FINISHED WORK IN WHICH IT IS USED, INCLUDING CRACKING. /7 <br />CONCRETE IS A PERISHABLE COMMODITY AND BECOMES THE PROPERTY OF THE PURCHASER UPON LEAVING THE LEAVE JOB <br />PLANT. ANY CHANGES OR CANCELLATIONS OF ORIGINAL INSTRUCTIONS MUST BE TELEPHONED TO OFFICE BEFORE <br />LOADING STARTS. CUSTOMER IS RESPONSIBLE FOR PROVIDING A SUITABLE PLACE, ON CUSTOMER'S PROPERTY, <br />FOR DRIVERS TO WASH CHUTES AS NECESSARY. ANY CLEANUP COST OF CUSTOMER -PROVIDED WASHOUT SITE ARRIVE PLANT <br />OR REMOVAL OF TRACKED -MUD FROM STREETS AND ROADS WILL BE BILLED TO CUSTOMER. <br />SEE TERMS AND CONDITIONS ON REVERSE SIDE. READ FRONT AND REVERSE CAREFIULLY <br />BY: <br />CUSTOMER ID <br />THIS LOAD I DELIVERED <br />TRUCK IPLANT <br />INSTRUCTIONS <br />P.O. NUMBER <br />CODE <br />WATER ADDED <br />CUSTOMER SIGNATURE ATCUSTOMER'SREOUEST <br />LOAD NUMBER I JOB NUMBER I TIME I DATE <br />DELIVER TO <br />DESCRIPTION <br />:_�E ND0010.; 10. �; ;:sl SAND) jLURRY <br />EF ENV 1 RONMENT'Al._ FEE <br />17-1ORT 1 L.00",Al_. _ 4.5 to 5.75 Cyd <br />I SLUMP IDUEATJOB USE OF CONCRETE <br />,4-6t tc76.3-1 1 TRUCK .JUST Na 1.F.i OF" <br />F"'C.?C1T'H 1 LL LAND f= I L..L 6484 N WAVERLY RD <br />I._ T.NLiEN 973V`236, <br />CYLINDERS TAKEN <br />GALLONS ❑ YES ❑ NO <br />TICKET <br />DRIVER <br />TERMS <br />MEASURE I PRICE <br />WAITING TIME <br />SUB TOTAL <br />TAX <br />TOTAL <br />GRAND TOTAL <br />INVOICE/TICKET NO. <br />PRICE <br />TI,'l_rck Driver I_l-er' L i =.p Tickert NQM Ticket 1F ime Date <br />46 JUNIOR PH T. L I P 34647 9: 25 10:' 16, <br />i._oacl Site Min Code Fietl_tr-ried Oty Mix Age Gkq La%�d IP <br />5. 00 yd SAND00103 D :36957 <br />Material Design Qty Re uired Batched % Var % Moisture Actual Wat <br />SAND 1101 2850 lb 1519 lb 15060 lb -0.30% 6.00% N 102 gl <br />CEMENT 869.0 lb 4840.0 lb 4870.0 lb 0.62% <br />WATER 40.00 gl 117.54 gl 117.00 gl -0.46% 117.00 gl <br />Actual Num Batches: 1 <br />Load Total: 20906 lb Design 0.345 Water/Cement 0.376 A Design 200.0g1 Actual 219.2' l To Add: 0. <br />Slump: 6.00 in' # Water in Truck: 0.0 gl Adjust Water -.O.@ 1 / Load Trio water: 3.0 g1/ yd g <br />Act real W/C Ratio: 0.376 Actual Water: 219 gl Batched Cemenk: 4870 lb Allowable Water: 0 lb <br />
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