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07-0819n,,Q,Mil 11, Vn JGVUU OdiI viayu, %,M vc I I nivertiluu, VIA yLO 10 Tel: 714.632. Tel: 858.537 3999 Tel: 951.653.4999 1 Fax: 714.632 Fax: 858.537.3990 Fax: 951.653.4666 Dispatch: 800. 990 Dispatch: 888.844.50% Dispatch: 800.491.2990 FIELD REPORT TYPE OF WORK 0 INSPECTOR NICIAN AVAILABLE: SOIL REPORT (Y)(N) SPECS (Y)(N) APPROVED PLANS (Y) (N) APPROVED SHOP DRAWING (Y) (N) ARCHITECTFOR WEEK ENDING PROJECT. NO. f ENGINEffEAARww Yv\ REPORT NO. PG OF CONTRACTOR SUB -CONTRACT PLAN FILE NO. PERMIT N0. �-7 - to PR ECT NAME jctr INSPECTION ADDRESS _ ADDRESS OF PROJECT REPORTING REQUIREMENTS: JCBO FIELD INSPECTION MANUAL/MTGI. SOIL MANUAL - REVIEW PREVIOUS REPORTS AND LISTS IF THERE IS NON -CONFORMING WORK AT THE END OF THE WORK DAY, OR MISSING MTRS, AND RFIS, ETC., FILL OUT AND ATTACH A DEFICIENCY REPORT WHEN A DEFICIENCY, YOURS OR A PREVIOUS INSPECTOR'S, IS CORRECTED, SO NOTE ON THE ORIGINAL DEFICIENCY REPORT AND SU13MIT A COPY WITH YOUR WEEK'S REPORTS. MATERIALS USD BY CON OR (INCLUDE RESEARCH C' ^N'0I �� TEST REPORTS e�' r�� CONTRACTORS EQUIPMENT/ OMPOWER USED: AREA, GRID LINES, PIECES OBSERVED: Gut�r- STRUCTURAL NOTES. DETAIL, OR RFIS USED: REMARKS, INCLUQ/NO METINGL ' r u n a 1 J '1—lx�, al"i G if 2 sea n "_`i`t� � UE -5 ns n l I*REWORK AS REACENT. OF' ALL WORK TODAY- PERCENT PROJECT COMPLETIONw WEATHER: C eoL r SAMPLES TAKEN: Cf� S_C, ` of TEMPERATURE 2 TESTS REQUIRED: Cc "kC: SS ICln s SITE TIME START: CO ` - SITE TIME FINISH: LUNCH PERIOD: TRAVEL TIME: VERIFIED BY� I DO CERTIFY THAT; IVE PERSONALLY OBSERVED ALL OF THE WORK LISTED ABOVE AND THAT THIS WORK COMPLIES WITH THE SOIL INVESTIGATION RECOMMENDATIONS, AND / OR THE APR D PLANS, SPECIFICATIONS AND APPLICABLE SECTION OF THE BUILDING CODE, UNLESS OTHERWISE NOTED IN THE DEFICIENCY REPORT A_/ 3/e `� Sig to Date of Report ICBG Certification Number PrintName City / County Certification Number Rev: 7/97 11. 1. 54 #= C. -C-MWD -13132 RAYIAR STREET #29 EL CAJON - 215 CYPRESS LANE *, I;" Hf - 7277 E ROSECRANS AVE #3D CORONA -1640 SHERBORN ST. 4rz i i s - 2E01 N. ALDER AVE - M tESPBtlA - 9661 C AVEMA i" ;drsc.F - 301 W. ROSECRANS AVE #32 UPLAND -1975 K BENSON #r ::=Ja PALMS -72460 VARNER ROAD #33 MIRAMAR- 5692 EASTGATE DRIVE A tl....ic A - 26190 ADAMS AVE #34 LUCERNE- 3MM HWY 18 #3 `-'r MESA - 7961 AIRWAY ROAD #35 BIS BEAR LAE - 42040 BTG BEAR ELYD. MAP PAGE TiCKE7 NO. CUSTOMER P.O. /JOB OR LOT # DRUM RE -Z ZEEVS: Job -s—..= �: =- s Yes 1.T _ TIMEONt,_ MIN. = Walef STAND BY MIN. CHECK El By r.:'i1 Ld. RATE OF X S PER MIN. CASH El T BY $ PLANT MGR SIG �= s "^ 1/3 Ld. ADJ. Meted"`r' 1 oading time allowed. ds; ` ARFM PLANT Adonalwateraddedtothisconcrete Win reduce itsstre o.Arp Ad:tiional unloading time charged at current hourly truck rate water added exceeding the design water is at the customs v vn'si. 1 TERMS AND CONDMNS OF SALE I 'R ung. _1 Rob�_,+m's 34vering the described material to a place designated by riCustom a —. Omer hereby releases and to indemnify and hold h�-r.;'ess Robertson's and +1 ees Ems/ > yrs for damage done by them, resu nom the rlover^e of Robe�r s .�:twes upon or about ft =IIecaUon. s� s n w,ledge _ � -e onared material has been chosen and selected soie'y'af Custome, a� . s�oertsoll's having reviewed any plans or specirlcations r2 j to Che project on which e •: �^z zr uses asps c de end, indemnify, and hold Roberson s tam.ess from a f 7 cls ms for relatin to said Inatenal Dei incompatible, Improper or ir. rssY w.^ plans z:z sx s or with the ground soils or conditions on the _ .sere the.-- a s }wed. to the t p ng inapp xray. in "4' a aftorted by law. C � merest s ay s : e sera �--fan:, attorney to collect payment for the is aAec a .-axials..' e s -re z agrees to payreasonable attorneys tee's incurred by Rea tsm's. ^" C::r3.-� ogr=es to pay a ate �rxae �:-•:;:at of 11296 per month on any amounts w�c . �bertson's tr „r,.s=_',:;a-s thirty (30) days. LD OTY CUM QTY ORD QTY PROD CODE t.'jX AND Cu`,'N'ODITY - UOM UNIT PR AMT AGREED TO AND RECENED BY CUSTOMER LUNCH PERIOD: TRAVEL TIME 9 WEIGHMASTER CERTIFICATE TILS ,-S : ' Mtn FY that the following described commodity was weighed, mea= ; ±counted by a weighmaster, %tole signature is on this certificate, who ts a ne-rt,nized authority o1 acz--ra--y_ as prescribed by Chapter 7 (corn - -- Wit Section 12700) of Drhs* : - me Cal ornia Business and Protassiors :ode. administered by to a-siorl 7l surair nt Standards of the art of Food and Aoria&n. ROBERTSON'S WEiGHMASTER LTY CEPUTY DELIVERY TICKET VERIFIED TAX PREVIOUS BALANCE SUB TOTAL STAND BY CHARGE TOTAL I DO CERTIFY THAT I HAVE PERSONALLY OBSERVED ALL OF THE WORK LISTED ABOVE AND THAT THIS WORK COMPLIES WITH THE SOIL INVESTIGATION RECOMMENDATIONS, AND / OR THE APR PLANS, SPECIFICATIONS AND APPLICABLE SECTION OF THE BUILDING CODE- UNLESS OTHERWISE NOTED IN THE DEFICIENCY REPORT Si W Date of Report ICSO Certification Number Print Name City / County Certification Number Ray. 7197 • Phone8OQS N_zx -.z .__ y e _,7 i2r- I • #1 NYOM - 6120 20Th ST. if 8 `.:.N CITY - 27050 WATSON RD. #15 VERB,: "--TIES - 333M E 25TH S' #2 MORENO VALLEY - 12890 DAY ST. # 9 W.RDWHEAD - 29750 HWY 18 #16 ANAHiII - 2.-.': E C01!L!E!?CIAL SL #3 REDLANDS - 8353 ALABAMA ST. to S.NrA FE SPRGS - 12311 GREENSTONE AVE. #17 SANTA AIIA - 310 IL TOWISB07 SE #4 FONTANA - 13792 SLOVER AVE #:! =QAZON - 13990 APACHE TRAIL #18 LAKE FOREST - 25931 TOWNE CENTRE C_ • #5 POMONA - 2470 POMONA BLVD. #6 HEMET)SAN =W0 1675 STATE SL #1;. SF1i BERNARDINO -1955 W. 9TH ST. "J WJIDALE 13631 LIVE OAK LANE #19 ADEIANTO - 12203 VIOLET RD. - :1 - F #20 SAN CLEMENTE - 116 RINCON CT. #7 BEAUMOJG - 452 W. LUIS ESTRADA RD. #u ?SADENA -1420 N. LINCOLN AVE #21 IRV81E -16081 CONSTRUCTION C9L W3: PLANT Dat ;`1. 5 OMER NO: SOLD TO: -X CD DE_17=_=' '=PZ— Z3,1.NS7-;,U+CTIONS ORDER NO. -, MEfERREADING-:67_--� -=_r•XLIC NO. LOAD NO. SLUMP t 11. 1. 54 #= C. -C-MWD -13132 RAYIAR STREET #29 EL CAJON - 215 CYPRESS LANE *, I;" Hf - 7277 E ROSECRANS AVE #3D CORONA -1640 SHERBORN ST. 4rz i i s - 2E01 N. ALDER AVE - M tESPBtlA - 9661 C AVEMA i" ;drsc.F - 301 W. ROSECRANS AVE #32 UPLAND -1975 K BENSON #r ::=Ja PALMS -72460 VARNER ROAD #33 MIRAMAR- 5692 EASTGATE DRIVE A tl....ic A - 26190 ADAMS AVE #34 LUCERNE- 3MM HWY 18 #3 `-'r MESA - 7961 AIRWAY ROAD #35 BIS BEAR LAE - 42040 BTG BEAR ELYD. MAP PAGE TiCKE7 NO. CUSTOMER P.O. /JOB OR LOT # DRUM RE -Z ZEEVS: Job -s—..= �: =- s Yes 1.T _ TIMEONt,_ MIN. = Walef STAND BY MIN. CHECK El By r.:'i1 Ld. RATE OF X S PER MIN. CASH El T BY $ PLANT MGR SIG �= s "^ 1/3 Ld. ADJ. Meted"`r' 1 oading time allowed. ds; ` ARFM PLANT Adonalwateraddedtothisconcrete Win reduce itsstre o.Arp Ad:tiional unloading time charged at current hourly truck rate water added exceeding the design water is at the customs v vn'si. 1 TERMS AND CONDMNS OF SALE I 'R ung. _1 Rob�_,+m's 34vering the described material to a place designated by riCustom a —. Omer hereby releases and to indemnify and hold h�-r.;'ess Robertson's and +1 ees Ems/ > yrs for damage done by them, resu nom the rlover^e of Robe�r s .�:twes upon or about ft =IIecaUon. s� s n w,ledge _ � -e onared material has been chosen and selected soie'y'af Custome, a� . s�oertsoll's having reviewed any plans or specirlcations r2 j to Che project on which e •: �^z zr uses asps c de end, indemnify, and hold Roberson s tam.ess from a f 7 cls ms for relatin to said Inatenal Dei incompatible, Improper or ir. rssY w.^ plans z:z sx s or with the ground soils or conditions on the _ .sere the.-- a s }wed. to the t p ng inapp xray. in "4' a aftorted by law. C � merest s ay s : e sera �--fan:, attorney to collect payment for the is aAec a .-axials..' e s -re z agrees to payreasonable attorneys tee's incurred by Rea tsm's. ^" C::r3.-� ogr=es to pay a ate �rxae �:-•:;:at of 11296 per month on any amounts w�c . �bertson's tr „r,.s=_',:;a-s thirty (30) days. LD OTY CUM QTY ORD QTY PROD CODE t.'jX AND Cu`,'N'ODITY - UOM UNIT PR AMT AGREED TO AND RECENED BY CUSTOMER LUNCH PERIOD: TRAVEL TIME 9 WEIGHMASTER CERTIFICATE TILS ,-S : ' Mtn FY that the following described commodity was weighed, mea= ; ±counted by a weighmaster, %tole signature is on this certificate, who ts a ne-rt,nized authority o1 acz--ra--y_ as prescribed by Chapter 7 (corn - -- Wit Section 12700) of Drhs* : - me Cal ornia Business and Protassiors :ode. administered by to a-siorl 7l surair nt Standards of the art of Food and Aoria&n. ROBERTSON'S WEiGHMASTER LTY CEPUTY DELIVERY TICKET VERIFIED TAX PREVIOUS BALANCE SUB TOTAL STAND BY CHARGE TOTAL I DO CERTIFY THAT I HAVE PERSONALLY OBSERVED ALL OF THE WORK LISTED ABOVE AND THAT THIS WORK COMPLIES WITH THE SOIL INVESTIGATION RECOMMENDATIONS, AND / OR THE APR PLANS, SPECIFICATIONS AND APPLICABLE SECTION OF THE BUILDING CODE- UNLESS OTHERWISE NOTED IN THE DEFICIENCY REPORT Si W Date of Report ICSO Certification Number Print Name City / County Certification Number Ray. 7197 Corporate: ( ,• s 2992 E. La Palma Ave. Ste. A Anaheim, CA' 92806 Tel: 714.632.2999 Fax: 714.632.2974 Dispatch: 800.491.2990 .y IN San Diego/Imperial 7313 Carroll Rd. Ste. G San Diego, CA 92121 Tel: 858.537.3999 Fax: 858.537.3990 Dispatch: 88 11 8.844.5060 FIELD REPORT Inland Empire: 14467 Meridian Pkw., Bldg. 2-A Riverside, CA 92518 Tel: 951.653.4999 Fax: 951.653.4666 Dispatch: 800.491.2990 TYPE OF WORK ❑ INSPECTOR P TECHNICIAN eT \ AVAILABLE: SOIL REPORT (Y) (N) SPECS (Y) (N) APPROVED PLANS (Y) (N) APPROVED SHOP DRAWING (Y) (N) ARCHITECT . FOR WEEK ENDING PROJECT. NO. 1t ENGINEER . %'� VIA 4{ V REPORT NO. PG OF CONTRACTOR PLAN FILE NO. PERMIT NO. SUB -CONTRACTOR) PROJECT NAME / f INSPECTION ADDRESS!! " ,L .� � I i ��u mv� 1 // (fit Ji A- Q. ADDRESS OF PROJECT REPORTING REQUIREMENTS: ICBO FIELD INSPECTION MANUAUMTGL SOIL MANUAL - REVIEW PREVIOUS REPORTS AND LISTS IF THERE IS.NON-CONFORMING WORK AT THE END OF THE WORK DAY, OR MISSING MTRS, AND RFIS, ETC., FILL OUT AND ATTACH A DEFICIENCY REPORT WHEN A DEFICIENCY, YOURS OR A PREVIOUS INSPECTOR'S, IS CORRECTED, SO NOTE ON THE ORIGINAL DEFICIENCY REPORT AND SUBMIT COPY WITH YOUR WEEK'S REPORTS. MATERIALS USED BY CONTRACTOR (INCLUDE RESEARCH REPORT NO. OR MATERIAL TEST REPORTS): ff _ iM► k 4L CONTRACTORS EQUIPMENT/ MANPOWER USED: AREA, GRID LINES, PIECES OBSERVED: 4 tN a c .t Tae- C -L) r s ���zcicrr� �c roc STRUCTURAL NOTES, DETAIL, OR RFIS USED: REMARKS, INCLUDING MEETINGS: 7[ ci /! e .➢ / �iR sit : f1,1 fi:C- r f f 1 1 �-. C._ � sa Lu C X REWORK AS PERCENT OF ALL WORK TODAY: PERCENT PROJECT COMPI ETIM WEATHER' C t' f TEMPERATURE: 2, SAMPLES TAKEN: i 7C �f �-�� TESTS REQUIRED: Mar C,SSICA- SITE TIME START: '� t>� SITE TIME FINISH: LUNCH PERIOD: TRAVEL TIME: VERIFIED BY: I UU c;EK I IHY I HAT I HAVE PERSONALLY OBSERVED ALL OF THE WORK LISTED ABOVE AND THAT THIS WORK COMPLIES WITH THE SOIL INVESTIGATION RECOMMENDATIONS, AN'D/ OR THE APPROVED PLANS, SPECIFICATIONS AND APPLICABLE SECTION OF THE BUILDING CODE, UNLESS OTHERWISE NOTED IN THE DEFICIENCY REPORT C) l Signature � _ Date of Report ICBO Certification Number P took Print Name City /County Certification Number Rev: 7/97 sF www.mtglinc.com Corporate: W—, 2992 E. La Palma Ave. Ste Anaheim, CA 92806 Tel: 714.632.2999 Fax: 714.632.2974 Dispatch: 800.491.2990 MTGL Project #: a7g574 09 Permit #_0 7C O Z9 Report # PG OF San Diego/Imperial Cow 7313 Carroll Rd. Ste. G San Diego, CA 92121 Tel: 858.537.3999 Fax: 858.537.3990 Dispatch: 888.844.5060 DAILY INSPECTION REPORT Inland Empire: 14467 Meridian Pkwy., Bldg. 2-A Riverside, CA 92518 Tel: 951.653.4999 Fax: 951.653.4666 Dispatch: 800.491.2990 DSA/CITY File #: DSA/OSHPD APPL #: DSA / LEA #: Special Inspection Reports must be distributed to the parties listed below within 14 days of the inspection. Reports of non-compliant conditions must be distributed immediately. Separate reports shall be prepared for each type of special inspection, on a daily basis. Each report shall be completed and signed by the special inspector conducting the inspection. PROJECTAM JP DATE ARCHITECT S. On ENGINEER TI E ARRIVED s VELJjME TIME EPARTED LU C TIME CONTRA94611 SUBCON CTOR INSPEC ADDR ADDRESS OFPROJECT TYP F INSPECTION ❑ BATCH PLANT ❑ NGINEERED FILL ❑ PT CONCRETE FOUNDATION ❑ SHOTCRETE ❑ BACK FILL ❑ CONCRETE ❑ MASONRY ❑ HIGH STRENGTH BOLTING ❑ WELDING ❑ SHOP WELD ❑ FIREPROOFING ❑ ANCHOR/DOWEL ❑ NDE FIELD ❑ NDE SHOP ❑ CEILING WIRE ❑ ❑ ❑ OSA/OSHPO/PROJECT: AVAILABLE: APPROVED DOCUMENTS: APPROVED PLANS Y ❑ SOIL REPORT Y ❑ N ❑ N ❑ SPECS: Y ❑ N ❑ APPROVED SHOP DRAWING Y ❑ N ❑ MATERIAC® BY CONTRACTO (INCLUDE RESEARCH REPORT NO. OR RIAL TEST REPORTS): CONTRACTORS EOUIPMENT I MANPOWER USED: AREA, GRID LINES, PIECES INSPECTE V 0rN 11-12 IL lb i STRUCTURAL NOTES, DETAIL, OR FINS USED: REMARKS, INCLUDING MEETINGS. REWORK AS PE ENT OF ALL WORK TODAY: PERCENT PROJECT COMPLETE: THE WORK WAS V WAS NOT ❑ Inspected in accordance with the requirements of the DSA/OSHPD/PROJECT approved documents. MATERIAL SAMPLING WAS P/WAS NOT ❑ N/A ❑ Performed in accordance with DSA/OSHPD/PROJECT approved documents. cc Project Architect Contractor Structural Engineer Building Department DSA Regional Office Owner School District THE WORK INSPECTED MET❑ DID NOT MEET❑ THE requirements o the DSAlO HPD/PR � ECT a ri Samples taken: Weather: !/1L . ) in/ 'Print Name Certification #: y� . �• Verified by: Corporate: 2992-E. La Palma Av6?Ste: A ®Anaheim, CA 92806 Tel: 714.632.2999 Fax: 714.632.2974 www.mtglinc.com // Dispatch: 800.491.2990 MTGL Project #: >/ 7 1tc� - 'fes � �l ;''i.r :•.t `. .: X"',-`r"iY:..a ..� San Diego/Imperial Coat. 7313 Carroll Rd. Ste. G San Diego, CA 92121 Tel: 858.537.3999 Fax: 858.537.3990 Dispatch: 888.844.5060 Oda DAILY INSPECTION Permit # REPORT Inland Empire: 14467 Meridian Pkwy., Bldg. 2-A --- Riverside, CA 92518 Tel: 9,51.653.4999 Fax: 951.653.4666 Dispatch: 800.491.2990 DSA/CITY File #: DSA/OSHPD APPL #: . Report # PG OF DSA / LEA #: Special Inspection Reports must be distributed to the parties listed below within 14 days of the inspection. Reports of non-compliant conditions must be distributed immediately. Separate reports shall be prepared for each type of special inspection, on a daily basis. Each report shall be completed and signed by the special inspector conducting the inspection. PROJECT pAME� 1 � L� KK DATE � — _ ARCHITECTTIME . ARRIVED TIME DEPARTED . . w 30 ENGINEERI I TAA ME LUNCH CONTR9GTU SUB CONTgpCTOR t �{s 0 INSPECTION ADDR 7Q-9 I )a o �� ADDRESS OF PROJECT " - 6� =7 �> TYPE'OF INSPECTION C% ❑`BATCH PLANT ❑/ENGINEERED FILL ❑ PT CONCRETE FOUNDATION ❑ SHOTCRETE ❑ BACK FILL ❑ CONCRETE ❑ MASONRY ❑ FIREPROOFING ❑ HIGH STRENGTH BOLTING ❑ ANCHOR/DOWEL ❑ WELDING ❑ NDE FIELD ❑ SHOP WELD ❑ NDE SHOP ❑ CEILING WIRE ❑ ❑ ❑ OSA/OSHPD/PROJECT: AVAILABLE: APPROVED DOCUMENTS: APPROVED PLANS Y ❑ N ❑ SOIL REPORT Y ❑ N ❑ SPECS: Y ❑ N ❑ APPROVED SHOP DRAWING Y ❑ N ❑- MATERIgLS USED BY CONTRACTO (INCLUDE RESEA�iCf� REPORT NO. OR M TERIAL TEST REPORTS): CONTRACTORS EQUIPMENT/ MANPOWER USED: AREA, GRID LINES, PIECES INSPECTED � YNA P _ e. __ r) j lf1Jl / O ut �0._L 1 © A , (�t )IR _ STRUCTURAL NOTES, DETAIL, OR FINS USED: REMARKS, INCLUDING MEETINGS. REWORK AS PERCENT OF ALL WORK TODAY: PERCENT PROJECT COMPLETE: THE WORK WASP WAS NOT❑ Inspected in accordance with the requirements of the DSA/OSHPD/PROJECT approved documents. MATERIAL SAMPLING WAS VWAS NOT ❑ N/A ❑ Performed in accordance with DSA/OSHPD/PROJECT approved documents. cc Project Architect Contractor Structural Engineer Building Department DSA Regional Office Owner School District THE WORK INSPECTED MET ❑ DID NOT MEET ❑ THE requirements o the DSA/OSHPD/PR/OJECT approved d Samples taken: .S' —k V e" , Weather: Sl ltU,Te 'MD) iT77i 0 Si - 1 �w />� / ' Print Name Certification #: f 7t / Verified by: A, 'e �� r'144 k . THIS IS NOT A TICKET NO. CONTROL NUMBER 569934 • ROBERTWN PO. BOX 3600, CORONA� Phone 800/834-7557 San reilIIIIIIII�IIINIIIIIIIIIIIIIUIIIhIgINIIIIIIIIINIIIIIIIII #1 RIVERSIDE - 6120 201h. ST. # 8 SUN CITY - 27050 WATSON RD. #15' VERNON-LOS ANGELES - 3365 E. 26TH ST. #2 MORENO VALLEY - 12890 DAY ST. # 9 ARROWHEAD - 29750 HWY 18 #16 ANAHEIM - 201 E. COMMERCIAL ST. #3 REDLANDS - 8353 ALABAMA ST. #10 SAMA FE SPRGS - 12311 GREENSTONE AVE. #17 SANTA ANA - 310 N. TOWNSEND ST. #4 FONTANA'- 13792 SLOVER AVE. #11 CABAZON - 13990 APACHE TRAIL. #18 LAKE FOREST - 25931 TOWNE CENTRE DR #5 POMONA - 2470 POMONA BLVD. #12 SAN BERNARDINO - 195j W. 9TH ST. #19 ADELANTO - 12103 VIOLET RD. #6 HEMET/SAN JACINTO - 1675 STATE ST. #13 IRWINDALE - 13631 LIVE OAK LANE ' '#14 #20 SAN CLEMENTE - 116 RINCON CT. #7 BEAUMONT - 452 W. WIS ESTRADA RD. PASADENA - 1420 N. LINCOLN AVE. #21 IRVINE - 16081 CONSTRUCTION CIR. WEST PLANT DATE CUSTOMER NO: SOLD TO: 11 11/29/07 85122 TIDWELL TX CD DELIVERY ADDRESS & INSTRUCTIONS 79793 HIGHWAY 111 j 1v11_5699343 #22 NO. HOLLYWOOD - 13132 RAYMER STREET #29 EL CAION - 215 CYPRESS LANE #23 PARAMOUNT - 7277 E. ROSECRANS AVE. #3D CORONA - 1540 SHERBORN ST. #24 RIALTO - 2601 N. ALDER AVE. #31 HESPERIA - 9661 C AVENUE #25 GARDENA - 301 W. ROSECRANS AVE. #32 UPLAND - 1975 N. BENSON #26 THOUSAND PALMS -72460 VARNER ROAD #33 MIRAMAR- 5692 EASTGATE DRIVE #27 MURRIETA - 26190 ADAMS AVE. #34 LUCERNE- 36555 HWY 18 #28 OTAY MESA - 7961 AIRWAY ROAD #35 BIG BEAR LAKE - 42040 BIG BEAR BLVD. MAP PAGE TICKET NO. CONCRETE. CONSTRUC. 5470A3 X699343 JEFFERSON LA QUINTA Jot) Phone : (7G0)275 --8l;33. BLDG D/ INTO ORDER NO. METER READING TIME TYPED TRUCK UC NO. 526 1701 . 00 ,5,9:`58 ; NEED - INTO LOAD NO. SLUMP TRUCK 1 3. 7 1028 / DRUM TO JOB REVS: CUSTOMER P.O. / JOB OR LOT # • 19`-333 708085 ( 780) 342 -83001 -AST TKS 2E. PLANT 26 DRIVER 2453 COOPER SCOTT WALL F'TG JOB START : 7:00 Job -site Cylinder Test: El Yes TIME ON JOB MIN. CHECK # ON JOB l Water added on job at STAND BY MIN. CHECK EICustomer's request: AMOUNT BY START POUR . �` I gals to Full LdRATE OF X $ PER MIN. CASH r..AMOUNT BY FINISH POUR �•,ry l gals to 2/3 Ld. $ PLANT MGR SIG ( _ gals t0 1/3 Ld. OVERTIMECHARGE LEAVE JOB ADJ. Meter4 1y1I N 4 min. per yd. unloading time allowed: ARRIVE PLANT „ Additional water added to this concrete will reduce its strength. Any Additional unloading time charged at current hourly truck rate water added exceeding the design water is at the customer's own risk. TERMS AND CONDITIONS OF SALE In consideration of Robertson's delivering the described material to a place designated by the Customer, the Customer hereby releases and agrees to indemnify and hold harmless Robertson's and its employees from all liability or claims for damage done by them, resulting from the movement of Robertson's vehicles upon or about the delivery location. Customer acknowledges that the described material has been chosen and selected sotey by Customer w thout Robertson's having rev awed any plans or specifications relating to the project on which the material is to be used. Customer agrees to defend, indemnity, and hold Robertson's harmless from all liability or claims for damage relating to sold material being inappropriate, incompatible, improper or inconsistent w th plans and specifications, or w th the ground soils or conditions on the land where the material is utilized, to the fullest eMent permitted bylaw. In event Robertson's rete ns the services of an attorneyy to collect payment for the described materials, the Customer agrees to pay reasonable attorney's fee's incurcad by Robertson's. Customer agrees to pay a time pr .differential of 1 %z% per month on any amounts owed to Robertson's. for more than thirty (30) days. LD QTY CUM QTY ORD QTY PROD CODE MIX AND COMMODITY UOM UNIT PR AMT 10.00 10.00 20.00 1085A 3000P/PL DEL.. CHARGE= CY 6 1 WEIGHMASTER CERTIFICATE 1 /Yi 1H(S I TO CERTIFY that the following described commodity was weighed, n V rilea&Liied', or counted by a weighmaster, whose 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 California Business and Professions Code, admjnistered,by Pe DMsio��rr�� of Measurement Standards of the Q California Department)of Fao� and Agnwfture` I E Y ROBERTSON'S WEIGHMASTER AGREED TO AND RECEIVED BY CUSTOMER TAX PREVIOUS BALANCE SUB TOTAL STAND BY CHARGE BY DEPUTY kt4Y 1 TOTAL DELIVERY TICKET 0 CONTROLTHIS IS NOT A TICKET NO. 98 S NUMBER OPEN 7 DAYS P.O. BOX3600, CORONA; CA92878-3600 1�� Phone 800/8347557 San Diego 800/870-1220 #1 RIVERSIDE - 6120 20th. ST. # 8 SUN CITY - 27050 WATSON RD. #15 VERNON-LOS ANGELES - 3365 E. 26TH ST. #22 NO. HOLLYWOOD - 13132 RAYMER STREET #29 EL CAJON - 215 CYPRESS LANE #2 MORENO VALLEY - 12890 DAY ST. # 9 ARROWHEAD - 29750 HWY 18 #16 ANAHEIM - 201 E. COMMERCIAL ST. #23 PARAMOUNT - 7277 E. ROSECRANS AVE. #30 CORONA - 1540 SHERBORN ST. #3 REDLANDS - 8353 ALABAMA ST. #10 SAMA FE SPRGS - 12311 GREENSTONE AVE. #17 SANTA ANA - 310 N. TOWNSEND ST. #24 RIALTO - 2601 N. ALDER AVE. #31 HESPERIA - %61 C AVENUE #4 FONTANA - 13792 SLOVER AVE. #11 CABAZON - 13990 APACHE TRAIL. #18 LAKE FOREST - 25931 TOWNE CENTRE DR. #25 GARDENA - 301 W. ROSECRANS AVE. #32 UPLAND - 1975 N. BENSON #5 POMONA - 2470 POMONA BLVD. #12 SAN BERNARDINO - 1955 W. 9TH ST. #19 ADELANTO - 12203 VIOLET RD. #26 THOUSAND PALMS -72460 VARNER ROAD #33 MIRAMAR- 5692 EASTGATE DRIVE #6 HEMET/SAN JACINTO - 1675 STATE ST. #13 IRWINDALE - 13631 LIVE 00 LANE / #20 SAN CLEMENTE - 116 RINCON CT. #27 MURRIETA - 26190 ADAMS AVE. #34 LUCERNE- 36555 HWY 18 #7 BEAUMONT - 452 W. LUIS ESTRADA RD. #14 PASADENA - 1420 N. LINCOLN AVE. #21 IRVINE - 16081 CONSTRUCTION CIR. WEST #28 OTAY MESA - 7961 AIRWAY ROAD #35 BIG BEAR LAKE - 42040 BIG BEAR BLVD. PLANT DATE CUSTOMER NO: SOLD TO: MAP PAGE TICKET NO. TX CD DELIVERY ADDRESS & INSTRUCTIONS CUSTOMER PO. / JOB OR LOT # ORDER NO. METER READING TIME TYPED TRUCK UC NO. LOAD NO. SLUMP TRUCK DRIVER DRUM REVS: Job -site Cylinder Test: ❑ Yes TO JOB TIME ON JOB MIN. CHECK # ON JOB Nater added on Job at STAND BY MIN. CHECK ❑ Customer's request: AMOUNT BY START POUR gals to FUII Ld. RATE OF X $ PER MIN. CASH ❑ AMOUNT BY FINISH POUR gals t0 2/3 Ld. $ PLANT MGR SIG gals to 1/3 Ld. OVERTIMECHARGE LEAVE JOB ADJ. Meter 4 min. per yd. unloading time allowed. ARRIVE PLANT Additional water added to this concrete will reduce its strength. Any Additional unloading time charged at current hourly truck rate water added exceeding the design water is at the customer's own risk. TERMS AND CONDITIONS OF SALE In consideration of Robertson's delivering the described material to a place designated by the Customer, the Customer hereby releases and agrees to indemnity and hold harmless Robertson's and its employees from alI liability or claims for damage done by them, resulting from the movement of Robertson's vehicles upon or about the detivery location. Customer acknowledges that the described material has been chosen and selected solely by Customer without Robertson's having reviewed any plans or specifications relating to the project on which the material is to be used. Customer agrees to defend, indemnify, and hold Robertson's harmless from all liability or claims for damage relating to said material being inappropriate, incompatible, improper or inconsistent with plans and specifications, or with the ground soils or conditions on the land where the material is utilized, to the fullest extent permitted by law. In event Robertson's retains the services of an attorney to collect payment for the described materials, the Customer agrees to pay reasonable attorney's fee's incurred by Robertson's. Customer agrees to pay a time price differential of 11/2% per month on any amounts owed to Robertson's for more than thirty (30) days. LD CITY CUM CITY ORD CITY PROD CODE MIX AND COMMODITY UOM UNIT PR AMT G 4 i TAX WEIGHMASTER CERTIFICATE s HIS IS TO CERTIFY that the following described commodity was weighed, basihed; or counted by a weighmaster, whose signature is on this certificate, PREVIOUS who is a recognized authority of accuracy, as prescribed by Chapter 7 (co, mencing with Section 12700) of Division 5 of the California Business and BALANCE p Professions Code, administered by the Division of Measurement Standards of the California Department of Food and Agriculture. SUB ROBERTSON'S TOTAL <' WEIGHMASTER i H� AGREED TO AND RECEIVED BY CUSTOMER BY DEPUTY DELIVERY TICKET STAND BY CHARGE TOTAL CONTROL �56��� R°OPEN 7 DAYS °NrS�„�llIII11IIIIIIIIIIIIIIIIIIIIINNIIAIIINIiIiWI&IIIIIIIIII #1 RIVERSIDE - 6120 201h. ST. #2 MORENO VALLEY - 12890 DAY ST. #3 REDLANDS - 8353 ALABAMA ST. #4 FONTANA - 13792 GLOVER AVE. #5 POMONA - 2470 POMONA BLVD. #6 HEMET/SAN JACINTO - 1675 STATE ST. #7 BEAUMONT - 452 W. LUIS ESTRADA RD. TINT IAY/ 2'D / 07 Phone 800/834-7557 San Diego 800/870-1220 *10105699358* # 8 SUN CITY - 27050 WATSON RD. #15 VERNON-LOS ANGELES - 3365 E. 26TH ST. #22 N0. HOLLYWOOD - 13132 RAYMER STREET #29 EL CAJON - 215 CYPRESS LANE # 9 ARROWHEAD - 29750 HWY 18 #16 ANAHEIM - 201 E. COMMERCIAL ST. #23 PARAMOUNT - 7277 E. ROSECRANS AVE. #30 CORONA - 1540 SHERBORN ST. #10 SAMA FE SPRGS - 12311 GREENSTONE AVE. #17 SAMA ANA - 310 N. TOWNSEND ST. N. #24 RIALTO - 2601 N. AIDER AVE. #31 HESPERIA - 9661 C AVENUE #11 CABAZON - 13990 APACHE TRAIL. #18 LAKE FOREST - 25931 TOWNE CENTRE DR. #25 GARDENA - W. ROSECRANS AVE. #32 UPLAND - 1975 N. BENSON #12 SAN BERNARDINO - 1955 W. 9TH ST. #19 ADELANTO - 12203 VIOLET RD. #26THOUSAND PALMS -72460 VARNER ROAD #33 MIRAMAR- 5692 EASTGATE DRIVE #13 IRWINDALE - 13631 LIVE OAK LANE #20 SAN CLEMENTE - 116 RINCON CT. #27 MURRIETA - 26190 ADAMS AVE. #34 LUCERNE- 36555 HWY 18 #14 PASADENA - 1420 N. LINCOLN AVE. d #21 IRVINE CONSTRUCTION CIA. WEST #28 OTAY MESA - 7961 AIRWAY ROAD #35 BIG BEAR LAKE - 42040 BIG BEAR BLVD. �r /16081 BY DEPUTY CU$TOMEQ NO: SOLD MAP PAGE TICKET NO. f'`71'r_'.c` i �NELL. CONCRETE CONSTRUC Z+Ik.IA3 :,Er,°=t':�,'58 TX CD Eyl04 i ONS7NS U 10 USTOMERPO./J�l�L#i'93:65 JEFFERSON •• LA QUI NTA ( 760) 342-8;300LAST Tt,,S 1.028 Job Phone : (760)275-8133 BLDG D/ INTO 26 ORDER NO,. ; METER READING TIME TYPED L TR CK CJVO ac.6 Ii CIt�ILI. eIL4 ; 4 7 7Lt�� bt1 INTO PLANT 26 LOAD NO. SUMP, TRUCK, DRIVER �. ;e ,12 11.x._1 HIBNER, MARIO WALL FTG DRUM JOB START : 7:00 r REVS: Job -site Cylinder Test: [].Yes TO JOB `+� ' �TIME ON JOB MIN. CHECK # ON JOB Water added on Job at STAND BY MIN. CHECK ❑ Customer's request: AMOUNT BY START POUR 1 gals to FUII Ld. RATE OF X $ PER MIN. CASH ❑ I AMOUNT BY FINISH POUR gals to 2/3 Ld. $ PLANT MGR SIG gals to 1/3 Ld. OVERTIME CHARGE - LEAVE JOB ADJ. Meter' M IN 4 min. per yd. unloading time allowed. ARRIVE PLANT Additional water added to this concrete will reduce its strength. Any Additional unloading time charged at current hourly truck rate water added exceeding the design water is at the customer's own risk. TERMS AND CONDITIONS OF SALE Inconsideration of Robertson's deliver ng the described material to a place designated by the Customer, the Customer hereby releases and agrees to indemnity and hold harmless Robertson's and its employees from all liability or claims for damage done by them, resulting from the movement of Robertson's vehicles upon or about the delivery location. Customer acknowledges that the described material has been chosen and selected solely by Customer without Robertson's having reviewed any plans or specifications relating to the project on which the material is t0 be used. Customer agrees t0 defend, indemnify, and hold Robertson's harmless from all liability or claims for damage relating to said material being inappropriate, incompatible, improper or inconsistent with plans and specifications, or with the ground so11s or conditions on the land where the material is utilized, to the fullest extent permitted by law. In event Robertson's retains the services of an attorneyy to collect payment for the described materials, the Customer agrees to pay reasonable attorney's fee's incurred by Robertson's. Customer agrees to pay a time price differential of t Yz%per month on any amounts owed to Robertson's for more than thirty (30) days. LD QTY CUM QTY ORD QTY' PROD CODE MIX AND COMMODITY UOM UNIT PR AMT 10.00. 20.00 00 20.00 1051PI 300OP/PL. Cy I i e3 qn.1�- DEL. CHARGE TAX WEIGHMASTER CERTIFICATE THIS IS TO CERTIFY that the fotlowing described commodity was weighed, measured, or counted by a weighmaster, whose signature is on this certificate, PREVIOUS who is a recognized authority of accuracy, as prescribed by Chapter 7 BALANCE ' (commencing with Section 12700) of Division 5 of the California Business and Professions Code, administered by the Division of Measurement Standards of the California Departmentso4F44aefidq �c��tyre: j��! SUB ROBERTSON'S TOTAL WEIGHMASTER STAND BY CHARGE BY DEPUTY TOTAL DELIVERY TICKET CONTROL THIS IS NOT A 71CKET NO. NUMBER 5699353 0 -1 OPEN 7 DAYS P0. BOX3600, CORONA, CA92878-3600 Phone 800/834-7557 San Diego aoo/s7a122o • *10105699358t #1 RIVERSIDE - 6120 20UL ST. # 8 SUN CITY - 27050 WATSON RD. • ,. #15 VERNON-LOS ANGELES - 3365 E. 26TH ST. , #22 N0. HOLLYWOOD - 13132 RAYMER STREET #29 EL CAJON - 215 CYPRESS LANE #2 MORENO VALLEY - 12890 DAY ST. '# 9 ARROWHEAD*- 29750 F WY 18 #16 ANAHEIM - 201 E. COMMERCIAL ST. #23 PARAMOUNT - 7277 E. ROSECRANS AVE. #30 CORONA - 1540 SHERBORN ST. #3 REDLANDS - 8353 ALABAMA ST. #10 SANTA FE SPAGS - 12311 GREE N' AVE. #17 SAMA ANA -:310 N. TOWNSEND ST. #24 RIALTO - 2601 N. ALDER AVE. #31 HESPERIA - 9661 C AVENUE #4 FONTANA- 13792 SLOVER AVE. #11 CABAZON - 13990 APACHE TRAIL. #18 LAKE FOREST - 25931 TOWNE CENTRE DR. •#25 GARDENA - 301 W. ROSECRANS AVE. .4#32 UPLAND - 1975 N. BENSON #5 POMONA - 2470 POMONA BLVD.N,#12 SAN BERNARDINO - 1955 W. 9TH ST. #19 ADELANTO ;12203 VIOLET RD. #26 THOUSAND PALMS -72460 VARNER ROAD #33 MIRAMAR- 5692 EASTGATE DRIVE #6 HEMET/SAN JACINTO - 1675 STATE ST- 413 IRWINDALE - 13631 LIVE OAK LANE - #20 SAN CLEMENTE -6 RINCON CT #27 MURRIETA - 26190 ADAMS AVE. 434 LUCERNE- 36555 HWY 18 i #7 BEAUMONT - 452 W. LUIS ESTRADA RD. #14 PASADENA - 1420 N. LINCOLN AVE. 11 #21 IRVINE - 16081 CONSTRUCTION CIR. WEST #28 OTAY MESA - 7961 AIRWAY ROAD #35 BIG BEAR LAKE - 42040 BIG BEAR BLVD. i� � T 11/c:5/07 °UFsi,� Ecc: solioiPWELL EONCRtTE •CONSTRUC 54/OA3 ter, 3�,,. 8 MAP PAGE TICKET f10. TX CD DELIVERY. ADDRESS &,INSTRUCTIONS ' , _ ! CUSTOMER P.O. /JOB OR LOT # r'y�, �11lanVtiF rY L 1 1 _ 1 `3g., , i V-16 7J JEFFERSON LA "OU INTA� ( 760) 342—8,_300LAST F TKS 1028 Job Ph on � �`t,._. i 7EQ�) 275-8133 SSG D1_7 INTO 26 ORDER NO,-, METER READING, TIME TYPED TRUCK UC NO, r 1 ��6 J , �uW. low# r, : 45 .7Lt�ul�a�t I INTO PLANT =6 ' t LOAD NO SLUMP. TRUCK 1 'DRIVER 1 fi I iNE R, _I3+1 I U 1 4 c - s, a0 ;� r _- 3 / 2 1 a . R _14ALL FTG _ - =� DRUM'*- �bB S•1 -ART 71`00' TO JOB �7� REVS'; Job -site Cylinder.Test: �,Y ,,�e� ( -t cT.IME ON JOB MIN. 4_. CHECK # .ON JOB ~1 Y Water a ` ed ori job at j STAND BY MIN. CHECK ❑ j' C6stor g's request: 4, AMOUNT Dv START POUR I r_gals to Full Ld. ,tRATEOFX$ PER MIN. CASH ❑ AMOUNT BY FINISH POUR =`^ gals to 2/3 Ld. f Iy1 $ OVERTIME CWGE PLANT MGR SIG gals to 1/3 Ld.- LEAVEJOB ~� ! ADJ. Meter_ MIN, - 4 min. per yd. unloading time allowed. ARRIVE PLANT Additional wateraddedtothisn� v11reduce itsstrenglh.Any _Z, Additional unloading time charged at current hourly truck rate water added exceeding the design wate is at the customer's own risk. L L 1 ` r ` TERMS AND CONDITIONS OF SALE In consideration of Robertson's delive(ng the described material to a place designated by the Customer, the Customenhereby releases and agrees to indemnity and hold harmless Robertson's and its employees from all liability or claims for damage done by them; resulting from the movement of Robertson's vehicles upon or about the delivery location. 4 Customer acknowledges that the described material has been chosen and selected solely by Customer without Robertson's having reviewed any plans or specifications relating to the project on which ` the material is to be used. Customer agrees to defend, indemnify, and hold Robertson's harmless from all liability or claims for damage relating to said material being inappropriate, incompatible, improper or inconsistent with plans and specifications, or with the ground soils or conditions on the land where the material is utilized, to the fullest extent permitted by law. In event Robertson's retains the services of an attorneyy to collect payment for the described materials, the Customer agrees to pay reasonable attorney's fee's incurred by Robertson's. Customer agrees to pay a time price differential o4_11/2% per month on any amounts owed to Robertson's fovmore than thirty (30) days. , LD QTY CUM QTY ORD QTY PROD CODE MIX AND COMMODITY UOM UNIT PR AMT 10.00 20.00 `0. 110 108544- '5000P/Ptlll - ICY '~ , `- '0EL:S1,1, CHARGE l TAX WEIGHMASTER CERTIFICATE THIS IS TO CERTIFY that.the following described commodity was weighed, DCmeasured, or counted by a weighmaster, whose signature is on this certificate, PREVIOUS \ who is a recognized authority of accuracy, as prescribed by Chapter 7 BALANCE (commencing with Section 12700) of Division 5 of the California Business and Professions Code, administered by the Division of Measurement Standards of the California Department offaod hAd Agri6ltur6. E Y SUB ROBERTSON'S TOTAL -7WEIGHMASTER STAND BY CHARGE \ BY DEPUTY ` TOTAL AGREED TO AND RECEIVED BY CUSTOMER DELIVERY -TICKET ` THIS IS NOT A TICKET NO. CONTROL P^Q �. NUMBER 3 li. OPEN 7 DAYS P.O. BOX 3600, CORONA, CA 92.878-3600 Phone 800/8347557 San Diego800/870-1220 .11 ,t #1 RIVERSIDE - 6120 201h. ST. #2 MORENO_VALLEY.- 12890 DAY ST. #3 REDLANDS - 8353 ALABAMA ST. #4 FONTANA - 13792 SLOVER AVE. #5 POMONA - 2470 POMONA BLVD. #6 HEMET/SAN JACINTO - 1675 STATE ST. #7 BEAUMONT - 452 W. LUIS ESTRADA RD. PLANT DATE 28 11/29/07 # 8 SUN CITY - 27050 WATSON RD. #15 VERNON-LOS ANGELES - 3365 E. 26TH ST # 9 ARROWHEAD_- 29750 HWY 18 #16 ANAHEIM - 201 E., COMMERCIAL ST. #10 SAMA FE SPNGS - 12311 GREENSTONE AVE. #17 SANTA ANA - 310,N. TOWNSEND ST. #11 CABAZON - 13990 APACHE TRAIL. #18 LAKE FOREST - 25931 TOWNE CENTRE D #12 SAN BERNARDINO - 1955 W. 9TH ST. #19 ADELANTO - 12203 VIOLET RD. #13 IRWINDALE - 13631 LIVE OAK LANE #20 SAN CLEMENTE - 116 RINCON CT. #14 PASADENA - 1420 N. LINCOLN AVE. #21 IRVINE - 16081 CONSTRUCTION CIR. WEST CUSTOMER NO: SOLD TO: 85122 TIDWELL ii"IIIIIII�iUIIIIII�IIIIIIIIIIII�IIIIIINIIIIIIINInIII@ �'h *101056939918* A. . #22 NO. HOLLYWOOD - 13132 RHYMER STREET #29 EL CAION - 215 CYPRESS LANE #23 PARAMOUNT - 7277 E. ROSECRANS AVE. #30 CORONA - 1540 SHERBORN, ST. ' #24 RIALTO - 2601 N. ALDER AVE. #31 HESPERIA - 9661. C AVENUE ' #25 GARDENA - 301 W. ROSECRANS AVE. #32 UPLAND - 1975 N. BENSON - #26 THOUSAND PALMS -72460 VARNER ROAD MURRIETA - 26190 ADAMS AVE. #33 MIRAMAR- 5692 EASTGATE DRIVE HN#27 #34' LUCERNE- 36555 H 18 >),- #28 OTAY MESA - 7961 AIRWAY ROAD #35 BIG BEAR LAKE -_42040 BIG BEAR BLVD. —MAP PAGE TICKET NO. CONCRETE CONSTRUC 5470A3 5693998 TX CD DELIVERY ADDRESS 8 INSTRUCTIONSCUSTOMER P.O. / JOB OR LOT # 79793 HIGHWAY 1.11 19933 708085 JEFFERSON LA GNUIIATA (760) 342--8300 AST TKS 11'5:5 Job Phbne : '(760)275-8133 BLDG D/ INTO 26 372 ORDER NO. f' METER READING TIME TYPED TRUCK UC NO. 526 1700.00 9:04 NEED LOAD NO. SLUMP TRUCK DRIVER 5 4 3.50'. 164 31 SCHNE I DE R, FRED WALL FTG � DRUM JOB START ART : 7: G0 TO JOB ��REVS: Job site Cylinder Test: ❑Yes TIME ON JOB MIN. CHECK # ON JOB 3v{ Water added On job at STAND BY MIN. CHECK ❑ ! Customer's request: .' AMOUNT BY START POUR gals to FUII Ld. RATE OF X $ PER MIN. CASH ❑ 1 AMOUNT BY FINISH POUR gals to 2/3 Ld. $ PLANT MGR SIG 1 gals to 1/3 Ld. OVERTIME CHARGE 1 LEAVE JOB ADJ. Meter4. M IN 4 min. per yd. unloading time allowed. ARRIVE PLANT Additional water added to this concrete will reduce its strength. Any Additional unloading time charged at current hourly truck rate water added exceeding the design water is at the customer's own risk. TERMS AND CONDITIONS OF SALE In consideration of Robertson's delivering the, described material to a place designated by the Customer, the Customer hereby releases and agrees to indemnify and hold, harmless Robertson's and its employees from all liability or claims for damage done by them, resulting from the movement of Robertson's vehicles upon or about the delivery location. Customer acknowledges that the described material has been chosen and selected solely by Customer w shout Robertson's having reviewed any plans or specifications relating to the project on which the material is to be used. Customer agrees to defend, indemnify, and hold Robertson's harmless from all liability or cla ms for damage relating to said material being inappropriate, incompatible, improper or inconsistent w th plans and specifications, or with the ground Solis or conditions on the land where the material is utilized, to the fullest extent permitted bylaw. In event Robertson's retains the sery ces of an attorneyy to collect payment for the described materials, the Customer agrees to pay reasonable attorney's fee's incurred by Robertson's. Customer agrees to pay a time price differential of 1, per month on any amounts owed to Robertson's for more than thirty (30) days. LD CITY CUM CITY ORD QTY PROD CODE MIX AND COMMODITY UOM UNIT PR AMT 10.00 40.01A 40.06 1085A AGREED TO AND RECEIVED BY, CUSTOMER 300OP/PL CY DEL. CHARGE TAX r WEIGHMASTER CERTIFICATE THIS IS TO CERTIFY that the following described commodity was weighed, measured, or counted by a weighmaster, whose signature is on this certificate, PREVIOUS who is a recognized authority of accuracy, as prescribed by Chapter 7 BALANCE (commencing with Section 12700) of Division 5 of the California Business and Professions Code, administered by the DMsion of Measurement Standards of the California Department.of Food and Agriculture. SUB Da V CRod-ur 0A'.S3 Lit TOTAL WEIOHMASTER STAND BY i CHARGE BY DEPUTY TOTAL DELIVERY TICKET THIS IS NOT A TICKET NO, ® NS CONTROL3998 •6 IM NUMBER 5-6939980 6 ;� - OPEN 7 DAYS P.O. BOX 3600, CORONA, CA 92878-3600 Phone 800/834-7557, SanDiego800/870-1220 #1 RIVERSIDE - 6120 201h. ST # 8 SON CITY - 27050 WATSON RD. #15 VERNON-LOS ANGELES - 3365 E. 26TH ST. #2 MORENO VALLEY, 12890 DAY SL # 9 AILROWHEAD - 29750 H1VY 18 #16 ANAHEIM - 201E. COMMERCIAL ST. #3 REDLANDS - 8353 ALABAMA ST #10 SAMA FE SPRGS - 12311 GREENSTONE AVE. #17 SAMA ANA - 310 N. TOWNSEND ST. #4FONTANA - 13792 SLOVER AVE. #11CABAZON - 13990 APACHE TRAIL. #18. LAKE FOREST - 25931 TOWNE CENTRE DR. #5 POMONA - 2470 POMONA BLVD. #12 SAN BERNARDINO - 1955 W. STH ST. #19 ADELANTO - 12203 VIOLET RD. #6 HEMET/SAN JACINTO - 1675 STATE ST. #13 IRWINDALE - 13631 LIVE OAK LANE #20 SAN CLEMENTE - 116 RINCON CT. #7 BEAUMONT - 452 W. LUIS ESTRADA RD. #14 PASADENA - 1420 N. LINCOLN AVE. #21 IRVINE - 16081 CONSTRUCTION CIR. WEST PLANT DATE 2E 11/29107 CUSTOMER NO: SOLD TO I II III IIII VIII I IIiIII{ *10105693998* #22 NO. HOLLYWOOD - 13132 RAYMER STREET #29 EL CAION - 215 CYPRESS LANE #23 PARAMOUNT - 7277 E. ROSECRANS AVE.— #30 CORONA -. 1540 SHERBORN�ST. #24 RIALTO - 2601 N. ALDER AVE. #31 HESPERIA -'9661; C AVENUE #25 GARDENA - 301 W. ROSECRANS AVE. ` #32 UPLAND - 1975 N. BENSON #26 THOUSAND PALMS -72460 VARNER ROAD #33 MIRAMAR- 5692 EASTGATE DRIVE #27 MURRIETA - 26190 ADAMS AVE. #34 LUCERNE- 36555 HVA' 18 #28 OTAY MESA - 7961 AIRWAY ROAD #35 BIG BEAR LAKE -42040 BIG BEAR BLVD. MAP PAGE TICKET NO. 85122 T I DWELL CONCRETE CONSTRUC 5471ZIA3 5169;3998 TX CD DELIVERY ADDRESS &INSTRUCTIONS CUSTOMER P.O. / JOB OR LOT # 79793 HIGHWAY 111 19933 718085 JEFFERSON LA GIUINTA (760)340:-•8300L.AST TKS 11°`j5 Job Phone : (760)275--8133 BLDG D/ INTO 26 372 ORDER NO. METER READING TIME TYPED TRUCK LIC N0. 5E6 170121. IZ10 9:04 NEED LOAD NO. SLUMP TRUCK DRIVER 4 3.30. 164 31 SC:HNE I DER, FRED WALL FT (3 �% DRUM ,JOB START : '7;00 TO JOB / r REVS: Job -site Cylinder Test: E]Yes TIME ON JOB MIN. CHECK # t Water added on job at ON JOB STANDBY MIN. CHECK ❑ ' Customer's request: AMOUNT BY START POUR j gals to Full Ld. RATE OF X $ PER MIN. CASH ❑ AMOUNT BY FINISH POUR/// gals to 2/3 Ld. '`.,_ _ $ PLANT MGR SIG l gals t0 1/3 Ld. OVERTIME CHARGE L LEAVE JOB - ADJ. MetO- M I N 1 4 min. per yd. unloading time allowed. ARRIVE PLANT Additional water added to this concrete will reduce its strength. Any , Additional unloading time charged at current hourly truck rate water added exceeding the design water is at the customer's own risk. t TERMS AND CONDITIONS OF SALE In consideration of Robertson's delivering the described material to a place designated by the Customer, the Customer hereby releases and agrees to indemnify and hold.harmless Robertson's and its employees from all liability or claims for damage done by them, resulting from the movement of Robertson's vehicles upon or about the delivery location. , Customer acknowledges that the described material has been chosen and selected solely by Customer w thout Robertson's having reviewed any plans or specifications relating to the projector which the material is to be used. Customer agrees to defend, indemnify, and hold Robertson's harmless from all liability or claims for damage relating to said material being inappropriate, incompatible, improper or inconsistent with plans and specifications, or vnth the ground soils or conditions on the land where the material is utilized, to the tallest eMent permitted bylaw.` In event Robertson's retains the services of an attorney to collect payment for the described materials-the'Customer agrees to pay reasonable attorney's tee's incurred by Robertson's. Customer agrees to pay a time price differential of 1'/z%per month on any amounts owed to Robertson's for more than thirty (30) days: �- LD QTY CUM QTY ORD OTY PROD CODE MIX AND COMMODITY UOM UNIT PR AMT .s J. 0. 00 40.00 40.00 1085A AGREED TO AND RECEIVED BY CUSTOMER 300OP/.PL C:Y a DEL...` G'I-IARCE l TAX WEIGHMASTER CERTIFICATE THIS IS TO CERTIFY that the following described commodity was weighed, measured, or counted by a weighmaster, whose signature is on this certificate, PREVIOUS who is a recognized authority of accuracy, as prescribed by Chapter 7 BALANCE ' (commencing with Section 12700) of Division 5 of the California Business and Professions Code, administered by the Division of Measurement Standards of the -California Department of Food and Agriculture. SUB D a V EROBERTSON/s) Lt TOTAL WEIGHMASTER STAND BY CHARGE BY DEPUTY TOTAL DELIVERY TICKET a THIS IS NOT A TICKET NO. CONTROL 11 NUMBER,ROMR :s • ( THIS IS TO CERTIFY that the following described commodity was weighed, measured, or counted by a weighmaster, whose signature is on this certificate, who is a recognized authority of accuracy, as prescribed by Chapter 7 PREVIOUS (commencing with Section 12700) of Division 5 of the California Business and BALANCE Professions Code, administered by the DMsion of Measurement Standards of the California Department of Food and Agriculture. i D a V 4EIGHMTA8TER Lt t TOTAL STAND BY '5694017 OPEN 7 DAYS ( � _ P.O. BOX 3600, CORONA, CA 9287 -3600 ii = i • Phone 800/8347557 San Diego 800/8701220 *10105694017* 1.a°RIVERSIDE - 6120'201h. ST. # 8 SUN CITY - 27050 WATSON RD. #15 VERNON-LOS ANGELES - 3365 E. 26TH ST. #2 MORENO VALLEY - 12890 DAY ST. # 9 ARROWHEAD - 29750 HWY 18 #16 ANAHEIM - 201 E. COMMERCIAL ST. #22 NO. HOLLYWOOD - 13132 RAYMER STREET #29 EL CAJON - 215 CYPRESS LANE #23 PARAMOUNT - 7277 E. ROSECRANS AVE. #30 CORONA - 1540 SHERBORN ST. #3 REDLANDS - 8353 ALABAMA SL #10 SANTA FE SPRGS - 12311 GREENSTONE AVE. #17SANTA ANA - 310 N. TOWNSEND ST. #24 RIALTO - 2601 N. ALDER AVE. #31 HESPERIA - 9661 C AVENUE #4 FONTANA - 13792 SLOVER AVE. #11 CABAZON - 13990 APACHE TRAIL. #18 LAKE FOREST - 25931 TOWNE CENTRE OIL #25 GARDENA - 301 W. ROSECRANS AVE. #32 UPLAND - 1975 N. BENSON #5 POMONA - 2470 POMONA BLVD. #12 SAN BERNARDINO - 1955 W. STH ST. #19 ADELANTO - 12203 VIOLET RD. #6 HEMET/SAN JACINTO - 1675 STATE ST. #13 IRWINDALE - 13631 LkOAK LANE #20 SAN CLEMENTE - 116 RINCON CT. #26 THOUSAND PALMS -72460 VARNER ROAD #33 MIRAMAR- 5692 EASTGATE DRIVE #27 MURRIETA - 26190 ADAMS AVE. #34 LUCERNE- 36555 HWY 18 #7 BEAUMONT - 452 W. WIS ESTRADA RD. #14 PASADENA - 1420 N. LINCOLN AVE. #21 IRVINE - 16081 CONSTRUCTION CIR. WEST #28 OTAY MESA - 7961 AIRWAY ROAD #35 BIG BEAR LAKE - 42040 BIG BEAR BLVD. 'LANT DATE CUSTOMER NO: SOLD TO: MAP PAGE TICKET NO. 2G 11/29/07 85122 TIDWELL. CONCRETE CONSTRUC 5470A3 5694017 TX CD DELIVERY ADDRESS & INSTRUCTIONS CUSTOMER P.O. / JOB OR LOT # 79793 HIGHWAY 111 19933 708085 JEFFERSON LA QUINTA (760)342°-8300LAST TKS 164 Jots Phone : (760)275--8133, BLDG D/ INTO 26 1155 )RDER NO. METER READING TIME TYPED TRUCK UC NO. 526 1700. 12710 10:25 8DS9755 OAD NO. SLUMP TRUCK DRIVER 5 3.50 1097 2705 REDD I N -W I LL I AM WALL_ FTC DRUM JOB START -.7:00 �O�j O (( REVS: Job -site Cylinder Test: ❑ Yes TO JOB TIME ON JOB MIN. CHECK # ON JOB i i j` Nater added on job at STAND BY MIN. CHECK ❑ CUStomer'S,request: AMOUNT BY START POUR gals to Full Ld. RATE OF X $ PER MIN. CASH ❑ AMOUNT BY FINISH POUR gals to 2/3 Ld. $ PLANT MGR SIG gals t0 1/3 Ld. OVERTIMECFMGE LEAVE JOB ADJ. Meter4. M I N 4 min. per yd. unloading time allowed. ARRIVE PLANT Additional water added to this concrete will reduce its strength. Any Additional unloading time charged at current hourly truck rate water added exceeding the design water is at the customer's own risk. TERMS AND CONDITIONS OF SALE In consideration of Robertson's delivering the described material to a place designated by the Customer, the Customer herreleases and agrees to indemnify and hold harmless Robertson's and its employees from all liability or claims for damage done by them, resulting from the movement of Robertson's vehicles upon or about the delivery location. Customer acknowledges that the described material has been chosen and selected solely by Customer without Robertson's having reviewed any plans or specifications relating to the project on which the material is to be used. Customer agrees to defend, indemnify, and hold Robertson's harmless from all liability or claims for damage relating to said material being inappropriate, incompatible, improper or, inconsistent with plans and specifications, or with the ground soils or conditions on the land where the material is utilized, to the fullest extent permitted by law. In event Robertson's rata ns the senrices of an attorney to collect payment for the described materials, the Customer agrees to pay reasonable attorney's fee's incurred by Robertson's. Customer agrees to pay a time price differential of 1'/z% per month nanyamounts owed to Robertson's for more than thirty (30) days. LD QTY CUM QTY ORD CITY PROD CODE MIX AND COMMODITY UOM UNIT PR AMT 4.60 44.00 44.00 1085A 300OP/PL CY DEL. CHARGE BY DEPUTY DELIVERY TICKET TOTAL TAX WEIGHMASTER CERTIFICATE THIS IS TO CERTIFY that the following described commodity was weighed, measured, or counted by a weighmaster, whose signature is on this certificate, who is a recognized authority of accuracy, as prescribed by Chapter 7 PREVIOUS (commencing with Section 12700) of Division 5 of the California Business and BALANCE Professions Code, administered by the DMsion of Measurement Standards of the California Department of Food and Agriculture. SUB D a V 4EIGHMTA8TER Lt t TOTAL STAND BY CHARGE BY DEPUTY DELIVERY TICKET TOTAL THIS 1S NOT A na(ET NO. CONTROL -7 NUMBER %94011 10 OPEN 7 DAYS f z P.O. BOX 3600, CORONA, CA 92878600 Phone 800/8347557 San Diego 800/870-1220 '41",,RIVERSIDE - 6120 201h. ST( #2 MOIIENO VALLEY - 128901DAY ST. #3 REDLANDS - 8353 ALABAMA ST. #4 FONTANA- 13792 SLOVER AVE. #5 POMONA - 2470 POMONA BLVD. #6 HEMET/SAN JACINTO - 1675 STATE ST. #7 BEAUMONT - 452 W. LUIS ESTRADA RD. PLANT DATE 26. 11/29/07 # 8 SUN CITY - 27050 WATSON RD. #15 VERNON-LOS ANGELES - 3365 E. 26TH ST. # 9 ARROWHEAD - 29750 HWY 18 #16 ANAHEIM - 201 E. COMMERCIAL ST. #10SANTA FE SPRGS - 12311 GREENSTONE AVE. #17 SANTA ANA - 310 N. TOWNSEND ST. ,- #11 CABAZON - 13990 APACHE TRAIL. #18 LAKE FOREST - 25931 TOWNE CENTRE DR. #12 SAN BERNARDINO - 1955 W. 9TH ST. #19 ADELANTO - 12203 VIOLET RD. #13 IRWINDALE - 13631 LIVE OAK LANE #20 SAN CLEMENTE - 116 RINCON CT. #14 PASADENA - 1420 N. LINCOLN AVE. #21 IRVINE - 16081 CONSTRUCTION CIR. WEST CUSTOMER NO: SOLD TO: 8512.2 T I DWELL *10105694417R #22 N0. HOLLYWOOD - 13132 RAYMER STREET #29 EL CAJON - 215 CYPRESS LANE #23 PARAMOUNT - 7277 E. ROSECRANS AVE. #30 CORONA - 1540 SHERBORN ST. #24 RIALTO - 2601 N. ALDER AVE. #31 HESPERIA - 9661 C AVENUE #25 GARDENA - 301 W. ROSECRANS AVE. #32 UPLAND - 1975 N. BENSON #26 THOUSAND PALMS -72460 VARNER ROAD #33 MIRAMAR- 5692 EASTGATE DRIVE #27 MURRIETA - 26190 ADAMS AVE. #34 LUCERNE- 36555 HWY 18 #28 OTAY MESA - 7961 AIRWAY ROAD #35- BIG BEAR LAKE - 42040 BIG BEAR BLVD. MAP PAGE TICKET NO. CONCRETE CONSTRUC 5470A3 5694017 TX CD DELIVERY ADDRESS & INSTRUCTIONS CUSTOMER P.O. / JOB OR LOT # 79793 HIGHWAY 1 1. 1 19933 708085 JEFFERSON L.A QUI NTA ( 760) 342--8300LAST TKS 164 Job Phone : (760) 275-8133. BLDG D/ INTO 26 1155 ORDER NO. METER READING TIME TYPED TRUCK UC NO. 526 1.700.00 10:25 BD89755 LOAD NO. SLUMP TRUCK DRIVER 5 3.50 1097 2705 REDD I N• -W i LL I AM WALL FTG I! 1 y�V� O DRUM _JOB START : 7:X10 REVS: Job -site Cylinder Test: Yes TO JOB f f'" TIME ON JOB MIN. � CHECK # ON JOB 1100 A � Water added on job at .- w STAND BY MIN. CHECK ❑ i r Customer's request: AMOUNT BY START POUR I((/ // ///) gdls to FUII Ld. RATE OF X $ PER MIN. CASH ❑ AMOUNT BY FINISH POUR galsto 2/3 Ld. gals to 1/3FLd. $ OVERTIME CHARGE PLANT MGR SIG LEAVE JOB ' ADJ. Meter4- M IN 4 min. per yd. unloading time allowed. ARRIVE PLANT Additional water added to this concrete will reduce its strength. Any Additional unloading time charged at current hourly truck rate water added exceeding the design water is at the customer's own risk. TERMS AND CONDITIONS OF SALE Inconsideration of Robertson's d8'` el vering the described material to a place designated by the Customer, the Customer hereby releases and agrees to to and hold harmless Robertson's and its employees from all liability or claims (or damage done by them, resulting from the movement of Robertson's vehiGes upon or about the delivery location. Customer acknowledges that the described material has been chosen and selected solely by Customer without Robertson's having rev awed any plans or specifications relating to the project on which the material is to be used. Customer agrees to defend, indemnify, and hold Robertson's harmless from all,l ability or cla ms for damage relating to said material being inappropriate, incompatible, improper or inconsistent with plans and specifications, or Wath the ground soils or conditions on the land where the material is utilized, to the fullest extent permitted bylaw. In event Robertson's rete ns the services of an attorney to collect payment for the described materials, the Customer agrees to pay reasonable attorney's fee's incurced by Robertson's. Customer agrees to pay a time price differential of 1 per month on any amounts owed to Robertson's for more than thirty (30) days. LD QTY CUM OTY ORD QTY PROD CODE MIX AND COMMODITY UOM UNIT PR AMT `a•. x+11.1 44, 00 44.00 1085A C! AGREED TO AND RECEIVED BY CUSTOMER . 300111F -'/PL CY 'A DEL. CHARGE TAX WEIGHMASTER CERTIFICATE THIS IS TO CERTIFY that the following described commodity was weighed, measured, or counted by a weighmaster, whose signature is on this certificate, PREVIOUS who is a recognized authority of accuracy, as prescribed by Chapter 7 BALANCE (commencing with Section 12700) of Division 5 of the California Business and Professions Code, administered by the Division of Measurement Standards of the California Department of Food and Agriculture. t SUB _. Da V FROBERT$ON(S LI t TOTAL WEIGFIMASTER STAND BY CHARGE BY DEPUTY " TOTAL DELIVERY TICKET 'A San DiegoPmperial Coune- 7313 Carroll Rd. Ste. G San Diego, CA 92121 Tel: 858.537.3999 Fax: 858.537.3990 Dispatch: 888.844.5060 l DAILY INSPECTION Permit# 0789 REPORT Inland Empire: 14467 Meridian Pkwy., Bldg. 2-A Riverside, CA 92518 Tel: 951.653.4999 Fax: 951.653.4666 Dispatch: 800.491.2990 DSA/CITY File #:_ DSA/OSHPD APPL #: Report # PG OF DSA / LEA #: Special Inspection Reports must be distributed to the parties listed below within 14 days of the inspection. Reports of non-compliant conditions must be distributed immediately. Separate reports shall be prepared for each type of special inspection, on a daily basis. Each report shall be completed and signed by the special inspector conducting the inspection. Q LUNCH -7Y-MIS C7UJU. If( �_'7 Corporate: 2992 E. La Palma Ave. Ste. A LNo BATCH PLANT Anaheim, CA 92806 Tel: 714.632.2999 . Fax: 714.632.2974 vvww.mtglinc.com Dispatch: 800.491.2990 MTGL Proiect #: oZ A —A ► .4Z San DiegoPmperial Coune- 7313 Carroll Rd. Ste. G San Diego, CA 92121 Tel: 858.537.3999 Fax: 858.537.3990 Dispatch: 888.844.5060 l DAILY INSPECTION Permit# 0789 REPORT Inland Empire: 14467 Meridian Pkwy., Bldg. 2-A Riverside, CA 92518 Tel: 951.653.4999 Fax: 951.653.4666 Dispatch: 800.491.2990 DSA/CITY File #:_ DSA/OSHPD APPL #: Report # PG OF DSA / LEA #: Special Inspection Reports must be distributed to the parties listed below within 14 days of the inspection. Reports of non-compliant conditions must be distributed immediately. Separate reports shall be prepared for each type of special inspection, on a daily basis. Each report shall be completed and signed by the special inspector conducting the inspection. Q LUNCH -7Y-MIS C7UJU. If( �_'7 TYPE OF INSPECTION LNo BATCH PLANT ❑ MASONRY ❑ FIREPROOFING ❑ GA R ❑ ENGINEERED FILL ❑ PT CONCRETE ❑ HIGH STRENGTH BOLTING ❑ ANCHOR/DOWEL �I :t( ❑ FOUNDATION ❑ SHOTCRETE ❑ WELDING ❑ NDE FIELD O ❑ BACK FILL ❑ CONCRETE ❑ SHOP WELD ❑ NDE SHOP ❑ DSA/OSHPO/PROJECT- AVAILABLE: SOIL REPORT Y ❑ N ❑ SPECS: Y ❑ N ❑ APPROVED DOCUMENTS: APPROVED PLANS Y ❑ N ❑ APPROVED SHOP DRAWING Y ❑ N ❑ MATERI$'YCO�NTR�C (INCLUDE RES HREPORT NO. OR ST REPORTS): ; � c ,I�e _9ins, /t CONTRACTORS EQUIPMENT/ MANPOWER USED AREA, GRID LINES, PIECES INSPECTED: I STRUCTURAL NOTES, DETAIL, OR RAS USED: I REMARKS, INCLUDING MEETINGS. II REWORK AS PE8CENT OF ALL WORK TODAY: PERCENT PROJECT COMPLETE: II THE WORK WAS G4 WAS NnT n Inspected in accordance with the requirements of the DSA/OSHPD/PROJECT approved documents. MATERIAL SAMPLING WAS/WAS NOT ❑ N/A ❑ Performed in accordance with DSA/OSHPD/PROJECT approved documents. cc Project Architect Contractor Structural Engineer Building Department DSA Regional Office Owner School District THF wnRK INCPFr:TFn MFT FI nln NnT MFFT FI THE requirements of Samples taken:_I Weather: Q )L Print Name Certification #: -51 • C i Verified by: 00V _', Corporate: .` 2992 E. La Palma e' S;t6 A: ®Anaheim 92806 Tel: 714.632.32.2999 Fax: 714.632.2974 www.mtglinc.com/�� Dispatch: 800.491.2990 MTGLProject#: r214 5— Vr'�_ .� � ' .� . San Diego/Imperial Cou t :; 7313 Carroll Rd. Ste. G San Diego, CA 92121 Tel: 858.537.3999 Fax: 858.537.3990 Dispatch: 888.844.5060 �Q DAILY INSPECTION Permit# REPORT Report # PG OF Inland Empire: 14467 Meridian Pkwy., Bldg. 2-A —� Riverside, CA 92518 Tel: 951.653.4999 Fax: 951.653.4666 Dispatch: 800.491.2990 DSA/CITY File #: DSA/OSHPD APPL #: DSA / LEA #: Special Inspection Reports must be distributed to the parties listed below within 14 days of'the inspection. Reports of non-compliant conditions must be distributed immediately.' Separate reports shall be prepared for each type of special inspection, on a daily basis. Each report shall be completed and sinned by the special inspector conducting the inspection: PROJECT NAME� t3 C DATE / Q ARCHITEICT — S . G. A. TIME ARRIVED 7:PIP TIME DEPARTED ENGINEER TRAVEL TIME LUNCH TIME CONTRACTOR ;� SUB CONTRA T R S INSPECTI N ADDRESS-\' -�4• I L� u) 11 ! aA a -fin DDRESS OF PROJECT � _� TYPE OF INSPECTION C ❑ BATCH PLANT ❑ ENGINEERED FILL ❑ PT CONCRETE ❑ FOUNDATION ❑ SHOTCRETE ❑ BACK FILL ❑ CONCRETE ❑ MASONRY ❑ HIGH STRENGTH BOLTING ❑ WELDING ❑ SHOP WELD ❑ FIREPROOFING ❑ ANCHOR/DOWEL ❑ NDE FIELD ❑ NDE SHOP ❑ ILING R_ [� ❑ ❑ DSA/OSHPD/PROJECT: AVAILABLE: APPROVED DOCUMENTS: APPROVED PLANS Y ❑ N ❑ SOIL REPORT Y ❑ N ❑ SPECS: Y ❑ N ❑ APPROVED SHOP DRAWING Y ❑ N ❑ MATER1 S USED BY CONTRA T R (INCLUDE RES A CH REPORT NO. OR ATERIAL'TEEST REPORTS): 1C.560 3 1342 5n -3 CONTRACTORS EQUIPMENT/ MANPOWER USED: AREA, GRID LINES, PIECES INSPECTED: lsvO u �t i C S IQA � t STRUCTURAL NOTES, DETAIL, OR FIRS USED: REMARKS, INCLUDING MEETINGS: i f 1 REWORK AS PERCENT OF ALL WORK TODAY: PERCENT PROJECT COMPLETE: THE WORK WAS 96 WAS NOT F-1 THE WORK INSPECTED MET❑ DID NOT MEET❑ Inspected in accordance with the requirements of the DSA/OSHPD/PROJECT ' 'THE requirements of he DSA/OStH-PD/PROJ CT approv d docu approved documents:, Samples taken: T ,1l, �� MATERIAL SAMPLING WAS WAS NOT ❑ N/A ❑ Weather: mp: , Performed in accordance with DSA/OSHPD/PROJECT approved documents. / y(/p�t{0.--A*'_ cc Project Architect Contractor Structural Engineer Building Department DSA Regional Office Owner School District ' 4\r !rj,ua i uto re, rP, C Print Name Certification #: // �✓ q •.V / �� t Verified by: - �1� THIS IS NOT ATICKET NO.q�cf� CONTROL NUMBER OPEN 7 DAYS • P.O. BOX 3600, CORONA, CA92878-3600 ' '1 W ^ `y Phone 800/8347557 SanDleg6800/8701220 *1O105693954* #1 RIVERSIDE - 6120 201h. ST. # 8 SUN CITY - 27050 WATSON RD. #15 VERNON-LOS ANGELES - 3365 E. 26TH ST. #22 NO. HOLLYWOOD - 13132 IIAYMEfl STREET #29 EL CAJON - 215 CYPRESS LANE #2 MORENO VALLEY - 12890 DAY ST. # 9 ARROWHEAD - 29750 HWY 18 #16 ANAHEIM - 201 E. COMMERCIAL ST #23PARAMOUNT - 7277 E. ROSECRANS AVE. #30 CORONA - 1540 SHERBORN ST. #3 REDLANDS - 8353 ALABAMA ST #10 SANTA FE SPRGS - 12311 GREENSTONE AVE. #17 SANTA ANA - 310 N. TOWNSEND ST. #24 RIALTO - 2601 N. ALDER AVE. #31 HESPERIA - 9661 C AVENUE #4 FONTANA - 13792 SLOVER AVE. #11 CABAZON - 13990 APACHE TRAIL. #18 LAKE FOREST - 25931 TOWNE CENTRE DR. #25 GARDENA - 301 W. ROSECRANS AVE. #32 UPLAND - 1975 N. BENSON #5 POMONA - 2470 POMONA BLVD. #12 SAN BERNARDINO - 1955 W. 9TH ST. #19 ADELANTO - 12203 VIOLET RD. #26 THOUSAND PALMS -72460 VARNER ROAD #33 MIRAMAR- 5692 EASTGATE DRIVE #6 HEMET/SAN JACINTO - 1675 STATE ST. #13 IRWINDALE - 13631 LIVE OAK LANE #20 SAN CLEMENTE -:116 RINCON CT. #27 MURRIETA - 26190 ADAMS AVE. #34 LUCERNE- 36555 HWY 18 ; #7 BEAUMONT - 452 W. LUIS ESTRADA RD. #14 PASADENA - 1420 N. LINCOLN AVE. #21 IRVINE - 16081 CONSTRUCTION CIR. WEST #28 OTAY MESA - 7961 AIRWAY ROAD #35 BIG BEAR LAKE - 42040 BIG BEAR BLVD. PLANT DATE CUSTOMER NO: SOLD TO: MAP PAGE TICKET NO. C.6 11 /29/07 56801 SOUTH COAST CONSTRUCTION 849J3 5693954 TX CD DELIVERY ADDRESS 8INSTRUCTIONS CUSTOMER PO. / JOB OR LOT # 79793 H TGHWAY Ill 62716 1. 516 • KOMAR DESERT" CENTER LA GIUINTA_ (951) 351--7777LAGT' TKS Jots Phone ; (951)774-0112 ORDER NO. METER READING TIME TYPED TRUCK LIC NO. 396. 1600.00 6:04 7X44127 LOAD NO. SLUMP TRUCK DRIVER 1 4.00 726 4336 LOPEZ '.ACTOR CURB&GUTTER[HAND F -OR DRUM - JOB START 7.00 TO JOB 6, REVS: Job -site Cylinder Test: ❑ Yes TIME ON JOB .' MIN. CHECK # f� /� ON JOB 60 • L�f AO Water added on job at STANDBY MIN. CHECK El Customer's request: AMOUNT BY START POUR gals t0 FUII Ld. RATE OF X $ PER MIN. CASH ❑ 4 ' AMOUNT BY FINISH POUR gals to 2/3 Ld.. $ PLANT MGR SIG gals to 1/3 Ld. OVERPMECFMGE LEAVE JOB ADJ. Meter$ M I N 4 min. per yd. unloading time allowed. ARRIVE PLANT Additionalwater added to this concrete will reduce HS strength. Any' Additional unloading time charged at current hourly truck rate water added exceeding the design water is at the customer's own risk. TERMS AND CONDITIONS OF SALE ,. Inconsideration of Robertson's delivering the described material to a place designated by the Customer, the Customer hereby releases and agrees to indemnify and hold harmless Robertson's and Cemployees from all liability or claims for damage done by them, resulting from the movement of Robertson's vehicles upon or about the delivery location. Customer . acknowledges that the described material has been chosen and selected solely by Customer without Robertson's having reviewed any plans or specifications relating to the project on which the material is to be used. Customer agrees to defend, indemnify, and hold Robertson's harmless from all liability or claims for damage relating to said material being Inappropriate, incompatible, improper ei 1• 1� or inconsistent with plans and specifications, or with the ground soils or conditions on the land where the material is utilized, to the fullest extent permitted by law. In event Robertson's retains the services of an attorney to collect payment for the described materials, the Customer agrees to pay reasonable attorney's fee's incurred by Robertson's. Customer agrees to time differential `t Fi pay a price of 11/2 per month on any amounts owed to Robertson's for more than thirty (30) days. LD OTY CUM OTY ORD QTY PROD CODE MIX AND COMMODITY UOM UNIT PR AMT T .110.00 20. 00 GC56QIB33 56OC3250 CY WATER ALLOWED 380.00 DEL. CHARGE WATER BITCHED 253.00 MOISTURE WATER 103.00 WEIGHMASTERCERTIFICATE TAX THIS IS TO CERTIFY that the following described commodity was weighed, 1� MAX ADD WATER, 4. 00 t= measured, or counted by a Itt weighmaster, whose signature is on this certificate, PREVIOUS 1 11 who is a recognized authority of accuracy, as prescribed by Chapter 7 CEMENT. # 4470, 00 BALANCE (commencing with Section 12700) of Division 5 of the California Business and ; F'LYASH # 1140. L71 .P Professions Code, administered by the Division of Measurement Standards of the California Department of Food and Agriculture. SUB F=INE AGG # 1.424.0. 00. Da V ]RdBERTSON'S, 0 TOTAL WEIGHMASTER 3/ES ACyG � # 3,040.00'• � � t :STANDBY 1 " A G G # 14080.00 00 1 .,CHARGE ' - BY DEPUTY•- - C! ;r TOTAL AGREED TO AND RECEIVED BY CUSTOMER DELIVERYTICKET PF THIS IS NOT A-ncKET NO. CONTROL 569395-7 OPEN 7 DAYS ��� NUMBER P.O. BOX3WO, CORONA, CA 9287&3600 �f• ���� 1l 11 ilk ��li� I�IE�IIIIII � ILII Phone 800/834-7557 San Diego 800/870-1220 z i 41 C 5 69 3 9 5 7 1 #1 RIVERSIDE - 6120 201h. ST. # 8 SUN CITY - 27050 WATSON RD. #15 VERNON-LOS ANGELES - 3365 E. 26TH ST. 922 N0. HOLLYWOOD - 13132 RHYMER STREET #29 EL CAJON - 215 CYPRESS LANE #2 MORENO VALLEY - 12890 DAY ST # 9 ARROWHEAD - 29750 HWY 18 #16 ANAHEIM - 201 E. COMMERCIAL ST. #23 PARAMOUNT - 7277 E. ROSECRANS AVE. #30 CORONA - 1540 SHERBORN ST. #3 REDLANDS - 8353 ALABAMA ST. #10 SAMA FE SPRGS - 12311 GREENSTONE AVE. #17 SAMA ANA - 310 N. TOWNSEND ST. #24 RIALTO - 2601 N. ALDER AVE. #31 HESPERIA - 9661 C AVENUE #4 FONTANA - 13792 SLOVER AVE. #it CABAZON - 13990 APACHE TRAIL.. #18 LAKE FOREST - 25931 TOWNS CENTRE DR. #25 GARDENA - 301 W. ROSECRANS AVE. #32 UPLAND - 1975 N. BENSON #5 POMONA - 2470 POMONA BLVD. #12 SAN BERNARDINO - 195j W. 9TH ST. #19 ADELANTO - 12203 VIOLET RD. #26 THOUSAND PALMS -72460 VARNER ROAD #33 MIRAMAR- 5692 EASTGATE DRIVE #6 HEMET/SAN JACINTO - 1675 STATE SL #13 IRWINDALE - 13631 LRE OAK LANE #20 SAN CLEMENTE - 116 RINCON CT. #27 MURRIETA - 26190 ADAMS AVE. #34 LUCERNE- 36555 HWY 18 #7 BEAUMONT - 452 W. WIS ESTRADA RD. #14 PASADENA - 1420 N. LINCOLN AVE. #21 IRVINE - 16081 CONSTRUCTION CIR. WEST #28 OTAY MESA - 7961 AIRWAY ROAD #35 BIG BEAR LAKE - 42040 BIG BEAR BLVD.. PLANT DATE CUSTOMER NO: SOLD TO: MAP PAGE TICKET NO. 26 .11/29/07 58101 SOUTH COAST CONSTRUCTION 849J3 569.3957 TX CD DELIVERY ADDRESS & INSTRUCTIONS CUSTOMER P.O. / JOB OR LOT # 79793 HIGHWAY 111 62716 1516 KOMAR DESERT CENTER LA QUINTA (951)351-7777LAST TKS 726 Jab Phone :'(951)714--0172, ORDER NO. METER READING TIME TYPED TRUCK LIC NO. 396 1600.00 6:19 7S47E54 LOAD NO. SLUMP TRUCK DRIVER u 4.00 702 5608 DEBOE DEAN CURB&GUTTER CHAND FOR ). DRUM JOB START 7:00 TO JOB ,I,���-� REVS: Job -Site Cylinder Test: F1 Yes TIME ON JOB MIN. CHECK # ON JOB /�✓ /t Water added on job at STAND BY MIN. CHECK ❑ �/Customer's request: s AMOUNT BY START POUR _ gals to FUII Ld. RATE OF X $ PER MIN. CASH ❑ ` AMOUNT BY FINISH POUR gals to 2/3 Ld. $ PLANT MGR SIG gals t0 1/3 Ld. OVERTIME CHARGE LEAVE JOB ADJ. Meter4 M I N 4 min. per yd. unloading time allowed. ARRIVE PLANT Additional water added to this concrete will reduce its strength. Any - Additional unloading time charged at current hourly truck rate q water added exceeding the design water is at the customer's own risk. TERMS AND CONDITIONS OF SALE Inconsideration of Robertso'n's delivering the described material to a place designated by the Customer, the Customer hereby releases and agrees to indemnity and hold her Robertson's and its employees from all liability or claims for damage done by them, resulting from the movement of Robertson's vehicles upon or about the delivery location. Customer acknowledges that the described material has been chosen and selected solely by Customer without Robertson's he ng reviewed any plans or specifications relating to the project on which the material is to be used. Customer agrees to defend, indemnity, and hold Robertson's harmless from all liability or claims for damage relating to said material being inappropriate, incompatible, improper or inconsistent with plans and Specifications, or w th the ground soils or conditions on the land where the material is utilized, to the fullest extent permitted bylaw.. In event Robertson's Teta ns the services of an attorney to collect payment for the described materials, the Customer agrees to pay reasonable attorney's fee's incurred by Robertson's. Customer agrees to pay a time price differential of 1 %z% per month on any amounts owed to Robertson's for more than thirty (30) days. LD QTY CUM QTY ORD OTY PROD CODE MIX AND.COMMODITY UOM UNIT PR AMT 10.00 20.00 20.00 GC!�E1ZIB33 56OC3250 CY WATER ALLOWED ?.,80.00 DEL. CHARGE WATER BATCHED 257.50 TAX MOISTURE WATER 99.00 WEIGHMASTER CERTIFICATE ►`iit777��tt ��{ THIS IS TO CERTIFY that the following described commodity was weighed, MAX ADD WATER 223.50 measured, or counted by a weighmaster, whose signature is on this certificate, PREVIOUS f f Al i I CEMENT $R x, 4442% 00 , who is a recognized authority of accuracy, as prescribed by Chapter 7 (commencing with Section 12700) of Division 5 of the California Business and BALANCE ' FLYASH #1120.00 ; Professions Code, administered by the Division of Measurement Standards of the California Department of Food and Agriculture. SUB FINE AGG # 1432.0.00 DaviRQBEVA50N'sp WEIGHN;<ASTER TOTAL 3/8 AGG # 3080. 4.10 STAND BY 1 11 AGG # 14080. 00 CHARGE BY DEPUTY TOTAL ' AGREED TO AND RECEIVED BY CUSTOMER DELIVERY TICKET THIS IS NOT A =PET NO. ONS CONTROL NUMBER OPEN 7 DAYS P.O. BOX 3600, CORONA, CA 92878-36DO Phone 800/834-7557 San Diego 800/870-1220 #1 RIVERSIDE - 6120 20th. ST. #2 MORENO VALLEY - 12890 DAY ST. #3 REDLANDS - 8353 ALABAMA ST. #4 FONTANA- 13792 SLOVER AVE. #5 POMONA - 2470 POMONA BLVD. #6 HEMET/SAN JACINTO - 1675 STATE ST. #7 BEAUMONT - 452 W. LUIS ESTRADA RD. PLANT DATE 26 11/29/07 # 8 SUN CITY - 27050 WATSON RD. # 9 AflROWHEAD - 29750 HWY 18 #10 SAMA FE SPRGS - 12311 GREENSTONE AVE. #11 CABAZON - 13990 APACHE TRAIL. #12 SAN BERNARDINO - 1955 W. 9TH ST. #13 IRWINDALE - 13631 LIVE.OAK LANE #14 PASADENA - 1420 N. LINCOLN AVE. #15 VERNON-LOS ANGELES - 3365 E. 26TH ST. #16 ANAHEIM - 201 E. COMMERCIAL ST. #17 SANTA ANA - 310 N. TOWNSEND ST.' #18 LAKE FOREST - 25931 TOWNE CENTRE DR #19 ADELANTO - 12203 VIOLET RD. #20 SAN CLEMENTE - 116 RINCON CT. #21 IRVINE - 16081 CONSTRUCTION CIR. WEST 1:114it"i�!iNi iii iiiliiii ii ii i Hi ii #22 NO. HOLLYWOOD - 13132 RAYN ER STREET #29 EL CAION - 215 CYPRESS LANE #23 PARAMOUNT - 7277 E. ROSECRANS AVE. #30 CORONA - 1540 SHERBORN ST. #24 RIALTO - 2601 N. ALDER AVE. #31 HESPERIA - 9661 C AVENUE #25 GARDENA - 301 W. ROSECRANS AVE. #32 "UPLAND - 1975 N. BENSON #26 THOUSAND PALMS -72460 VARNER ROAD #33 MIRAMAR. 5692 EASTGATE DRIVE #27 MURRI ETA - 26190 ADAMS AVE. #34 LUCERNE- 36555 HWY 18 #28 OTAY MESA - 7961 AIRWAY ROAD #35 BIG BEAR LAKE - 42040 BIG BEAR BLVD. CUSTOMER NO: SOLD TO: MAP PAGE TICKET NO. 588L -A1 SOUTH COAST CONSTRUCTION 849J3 5693957 TX CD DELIVERY ADDRESS & INSTRUCTIONS CUSTOMER P.O. / JOB OR LOT # 79793 HIGHWAY 1 1 1 62 716 .1516 KOMAR DESERT CENTEFR LA GIU I NTA ( 55,1) 351 -- 7777LAST 'ms 726 Job Phone : (951)774---0172. ORDER NO. METER READING TIME TYPED TRUCK UC NO. 396 1600.00 8:19 7547254 LOAD NO. SLUMP TRUCK DRIVER 2 4.00 702 561 8 DEPOE DEAN CURB&GUTTER CHAJD FOR DRUM JOP START : 7: 00 TO JOB V REVS: y Job-3ite Cylinder Test: ❑ Yes TIME ON JOB MIN. CHECK # ON JOBS falj Water added on job at Customer's request: STANDBY MIN. CHECK ❑ AMOUNT BY START POUR L gals to FUII Ld. RATE OF X $ PER MIN. CASH ❑ AMOUNT BY FINISH POUR gals to 2/3 Ld. gals to 1/3 Ld. $ OVERTIMECFMGE PLANT MGR SIG LEAVE JOB &00 ADJ. Meter4 M I Ny 4 min. per yd. unloading time allowed. ARRIVE PLANT Additional water added to this concrete will reduce its strength. Any Additional unloading time charged at current hourly truck rate water added exceeding the design water is at the customer's own risk. TERMS AND CONDITIONS OF SALE Inconsideration of Robertson's delivering the described material to,a place designated by the Customer, the Customer hereby releases and agrees to indemnify and hold he Robertson's and its employees from all liability or claims for damage done by them, resulting from the movement of Robertson's vehicles upon or about the delivery location. Customer acknowledges that the described mater al has been chosen and selected soley by Customer w shout Rdbertson's hav ng reviewed any plans or specifications relating to the project on which the material is to be used. Customer agrees to defend, indemnify, arid hold Robertson's harmless from all liability or claims for damage relating to said material being inappropriate, incompatible, improper or inconsistent w th plans and specifications, or with the ground soils or conditions on the land where the material is util zed, to the fullest event permitted by law. In event Robertson's retains the services of an attorneyy to collect payment for the described materials, the Customer agrees to pay reasonable attorney's fee's incurred by Robertson's. Customer agrees to pay a time price differential of t j/ per month on any amounts owed to Robertson's for more than thirty (30) days. LD QTY CUM QTY ORD QTY tPROiD CODE MIX AND- COMMODITY UOM UNIT PR AMT ... h 10.00 20.00 20.'00 Gr_r15L60B33 560C3250 CY I WATER At -LOWED 380.00 DEL. CHARGE MATER PATCHED 257.50 , MOISTURE WATER R T -J,. 00 WEIGHMASTER CERTIFICATE TAX THIS IS TO CERTIFY that the following described commodity was weighed, MAX N D D WATER 23.50 measured, or counted by a weighmaster, whose signature is on this certificate, PREVIOUS who is a recognized authority of accuracy, as prescribed by Chapter 7 CEMENT # 4440. IL10 (commencing with Section 12700) of Division 5 of the California Business and BALANCE Professions Code, administered by the Division of Measurement Standards of the F'LYASH # 1120. 00 California Department of Food and Agriculture. SUB FINE AGG # 14320.00 Da v iR I EarsON s O TOTAL WEIGFIIi S 3/8 AGG # 3080.00 STANDBY 1 r' 'AGG # 14080. OiZI CHARGE BY DEPUTY TOTAL AGREED TO AND RECEIVED BY CUSTOMER DELIVERY TICKET Corporate: • 2992 E. La Palma Ave. Ste. A Anaheim, CA 92806 Tel: 714.632.2999 Fax: 714.632.2974 www.mtglinc.com Dispatch: 800.491.2990 MTGL Project #:,2145,409 Permit# 0T9 UQ Report # PG OF San Diego/Imperial 7313 Carroll Rd. Ste. G San Diego, CA 92121 Tel: 858.537.3999 Fax: 858.537.3990 Dispatch: 888.844.5060 DAILY INSPECTION REPORT Inland Empire: 14467 Meridian Pkwy., Bldg. 2-A Riverside, CA 92518 Tel: 951.653.4999 Fax: 951.653.4666 Dispatch: 800.491.2990 OSA/CITY Fite DSA/OSHPD APPL DSA / LEA #-. Special Inspection Reports must be distributed to the parties listed below within 14 days of the inspection. Reports of non-compliant conditions must be distributed immediately. Separate reports shall be prepared for each type of special inspection, on a daily basis. Each report shall be completed and signed by the special inspector conducting the inspection. PROJECT NAME DATE ARCHITE T TIME ARRIVED TIM DEPARTED ENGINEE TRAVEL TIME LUNC IME CONTRA ORSUBCONTRACTOR -1k 4 11C a!)m0+1k coaeA C=4. INSPECTIO ORESS ADDRESS OF PROJECT TYPE OF INSPECTION BATCH PLANT ❑ ENGINEERED FILL ❑ PT CONCRETE ❑ FOUNDATION ❑ SHOTCRETE ❑ BACK FILL ❑ CONCRETE O MASONRY ❑ HIGH STRENGTH BOLTING ❑ WELDING O SHOP WELD ❑ FIREPROOFING O ANCHOR/DOWEL ❑ NDE FIELD O NDE SHOP ❑ CEILING WIRE ❑ ❑ ❑ DSA/OSHPO/PROJECT: AVAILABLE: APPROVED DOCUMENTS: APPROVED PLANS YO NO SOIL REPORT Y❑ NO SPECS: YO NO APPROVED SHOP DRAWING YO N MATERIA USED BY CONTRACTOR!INCLUDE RESEARC PORT NO. OR MATERIAL TEST REPORTS): CONTRACTORS EOUIPMENT I MANPOWER USED: AREA, GRID LINES, PIECES INSPECTED: 4n q STRUCTURAL NOTES, DETAIL, OR RFIS USED: REMARKS, INCLUDING MEERNGS. REWORK AS PEt CENT OF ALL WORK TODAY: PERCENT PROJECT COMPLETE: THE WORK WAS I WAS NOT ❑ . Inspected in accordance with the requirements of the DSA/OSHPD/PROJECT approved documents.. - MATERIAL SAMPLING WAWAS NOT O N/A O Performed in accordance with SA/OSHPD/PROJECT approved documents. cc Project Architect Contractor Structural Engineer Building Department DSA Regional Office Owner School District THE WORK INSPECTED MET ❑ DID NOT MEET ❑ THE requirements of the DSA/0$HPD/PRO KCT appy T Print Name Certification: 71 /'C - �• r Verified by: Arr":w "LLUIAL www.mtglinc.com ' Corpor r�� 2992 E. La alma Ave.:Sfe�.. A Anaheim, CA 92806 Tel: 714.632.2999 Fax: 714.632.2974 Dispatch: 800.491.2990 MTGL Project #: C2 / #1 '.5A ()9- Permit # 0 -7-9 IQ Report # PG OF .... :\ .;tF.tr'.-.. _,!i.4 +tti: si3M•5c-i».�wa3icyrc.tS s ` San Diego/Impe ount3^ 7313 Carroll Rd. Ste. G San Diego, CA 92121 Tel: 858.537.3999 Fax: 858.537.3990 Dispatch: 888.844.5 060 DAILY INSPECTION REPORT Inland Empire: 14467 Meridian Pkwy., Bldg. 2-A ' Riverside, CA 92518 Te I: 951.653.4999 Fax: 951.653.4666 Dispatch: 800.491.2990 DSA/CITY File #: DSA/OSHPO APPL #: DSA / LEA #: Special Inspection Reports must be distributed to the parties listed below within 14 days of the inspection. Reports of non-compliant conditions must be distributed immediately. Separate reports shall be prepared for each type of special inspection, on a daily basis. Each report shall be completed and signed by the special inspector conductina the inspection. PROJECT NAME Krt im P P DATE f- JA- Q ARCHITECT ^� TIME ARRIVED ' TIME DEPARTED ENGINEER TRAVEL TIME LUNCH IME CONTRACTORSUBCONTRACTOR �© !k _k Nts INSPECTION"DRESS -7 -mac VkWu tit t31.11 �- ADDRESS OF PROJECT TYPE OF INSPECTION BATCH PLANT ❑ ENGINEERED FILL ❑ PT CONCRETE ❑ FOUNDATION ❑ SHOTCRETE ❑ BACK FILL ❑ CONCRETE ❑ MASONRY ❑ FIREPROOFING ❑ HIGH STRENGTH BOLTING ❑ ANCHOR/DOWEL ❑ WELDING ❑ NDE FIELD ❑ SHOP WELD ❑ NDE SHOP ❑ CEILING WIRE D. El ❑ DSA/OSHPD/PROJECT: AVAILABLE: SOIL REPORT Y ❑ N ❑ SPECS: Y ❑ N ❑ APPROVED DOCUMENTS: APPROVED PLANS Y ❑ N ❑ APPROVED SHOP DRAWING Y ❑ N ❑ MATERIALS USED BY CONTRACTOR (INCLUDE RESEARCH REPORT NO. OR MATERIAL TEST REPORTS): �-+ L_ 100 CONTRACTORS EQUIPMENT I MANPOWER USED: AREA, GRID LINES, PIECES INSPECTED: C-' l (J I B 5 . ) 1t' , rniA cPk(= �r)( 00"�° , STRUCTURAL NOTES, DETAIL, OR RAS USED: .e f� REMARKS, INCLUDING MEETINGS: REWORK AS PERCENT OF ALL WORK TODAY: PERCENT PROJECT COMPLETE: THE WORK WAS 16 WAS NOT ❑ Inspected in accordance with the requirements of the DSA/OSHPD/PROJECT approved documents. MATERIAL SAMPLING WASJWAS NOT ❑ N/A ❑ Performed in accordance with DSA/OSHPD/PROJECT approved documents. cc Project Architect Contractor Structural Engineer Building Department DSA Regional Office Owner School District THE WORK INSPECTED THE requirements of the Samples taken: Weather: Sx lt/1 MET❑ DIDNOTMEET❑ OSA/OSHPD/PROJECT anon Print Name Certification #: 1,V, ` 7 ,,,-A A �• Verified by: M r 1=11 - THIS IS NOTA TICKET No. R® ONIS OUMBEOR $�!`dl 5693881 1 OPEN 7 DAYS leP.O. BOX 3600, CORONA, CA92878�600 • i 800/8347557 San Diego 800/ 870-1720 - 1 r,1G 5 69 8' 7 3 8 #1 RIVERSIDE - 6120 201h. ST. # 8 SUN CITY - 27050 WATSON RD. #15 VERNON-LOS ANGELES - 3365 E. 26TH ST. #22 NO. HOLLYWOOD - 13132 RAYMER STREET #29 EL CAION - 215 CYPRESS LANE #2 MORENO VALLEY - 12890 DAY ST. # 9 ARROWHEAD - 29750 HWY 18 #16 • ANAHEIM - 201 E. COMMERCIAL ST. #23 PARAMOUNT - 7277 E. ROSECRANS AVE. #30 CORONA - 1540 SHERBORN ST. #3 REDLANDS - 8353 ALABAMA ST #10 SAMA FE SPRGS - 12311 GREENSTONE AVE. #17 SAMA ANA - 310 N. TOWNSEND ST. #24 RIALTO - 2601 N. ALDER AVE. , #31 HESPERIA - 9661 C AVENUE #4 FONTANA - 13792 SLOVER AVE. #11 CABAZON - 13990 APACHE TRAIL. #18 LAKE FOREST - 25931 TOWNE CENTRE DR. #25 GARDENA - 301 W. ROSECRANS AVE. #32 UPLAND - 1975 N. BENSON #5 POMONA - 2470 POMONA BLVD. #12 SAN. BERNARDINO - 1955 W. 9TH ST. #19 ADELANTO - 12203 VIOLET RD. #26 THOUSAND PALMS -72460 VARNEH ROAD #33 MIRAMAR- $692 EASTGATE DRIVE#6 HEMET/SAN JACINTO - 1675 STATE ST. #13 IRWINDALE - 13631 LIVE OAK LANE #20 SAN CLEMENTE - 116 RINCON CT._ #27 MURRIETA - 26190 ADAMS AVE. #34 LUCERNE- 36555 HWY 18 #7 BEAUMONT ,,452, W. LUIS ESTRADA RD. #14 PASADENA - 1420 N. LINCOLN AVE. #21 IRVINE - 16081 CONSTRUCTION CIR. WEST #28 OTAY MESA - 7961 AIRWAY ROAD #35 BIG BEAR LAKE - 42040 BIG BEAR BLVD. PLANT DATE,. CUSTOMER NO: SOLD TO: MAP PAGE TICKET NO. 2G 1.1/28/07 58801 SOUTH COAST CONSTRUCTION 8y+9J 3 5693887 TX CD DELIVERY ADDRESS & INSTRUCTIONS +`1 1f CUSTOMER P.O. / JOB OR LOT # 7979�� H 161AWAY 111 G— 2684 1516 KOMAR DESERT CENTER LA QUINTA (951.) 3 a1.--7`1771_AST TICS Job d-1hone : (951 ) 7'74--0173. 1 ORDER NO. METER READING TIME TYPED TRUCK UC NO.' 412 ! 1 r00. 10 6 : 22 NEED LOAD N0. "SLUMP TRUCK DRIVER ' ` 1 4.00 i 1,5'P17 MIRACLE JIM CC1REx&GUi -TEREHAND FOR JOB START-_.-. 7.:Ij1►�1 DRUM 3b REVS: Job -site Cylinder Test: ElYes TO JOB - _ TIME ON JOB MIN. CHECK # QON JOB , ' Water added On job at STAND BY MIN. CHECK ElCustomer's request: AMOUNT BY START POUR gals to FUII Ld. RATE OF X $ PER MIN. CASH ❑ AMOUNT iBY FINISH POUR gals to 2/3 Ld. $ PLANT MGR SIG gals to 1/3 Ld. , OVERTIMECWGE LEAVE JOB ' ADJ. Meter4 M I N 4 min. per yd. unloading time allowed. ARRIVE PLANT 4 Additional water added to this concrete will reduce its strength.Anyy� Additional unloading time charged at current hourly truck rate water added exceeding the design water is at the customer's owfi nsk. t TERMS AND CONDITIONS OF SALE In consideration of Robertson's delivering the described material to a place designated by the Customer, the Customer hereby releases and agrees to indemnify and hold harmless Robertson's and its employees from all liability or claims for damage done by them, resulting from the movement otRobertson's vehicles upon or about ilia delivery location. r"' Customer acknowledges that the described mater al has been chosen and selected solely by Customer w thout Robertson's hav ng rev awed any plans or specifications relating to the project on which the material is to be used. Customer agrees to defend, indemnity, and hold Robertson's harmless from all liability or cla ms far damage relating to Bald material being inappropriate, incompatible, improper or inconsistent with plans and specificat9ns; 4C,with the ground soils or conditions on the land where the material is utilized, to the fullest eMent permitted bylaw. `, In event Robertson's retains thesenrices of an attorney to collect payment for the described materials, the Customer agrees to pay reasonable attorney's fee's Inc�rred by Robertson's. Customer agrees to pay a time price differential of 1 %z%per month on any amounts owed to Robertson's for more than thirty (30) days. 1 LD QTY CUM QTY t'st.ORD OTY PROD CODE MIX AND COMMODITY UOM �, UNIT PR AMT 10.00 10. GC560831 560C3260 C:Y WATER ALLOWED' WATER 8A-fCHEID t MOISTURE WATER MAX ADD WATER R CEMENT # EINE:. AGG •' 4 3/8 AGG # 1 11 AGG # i i 1 ?,80.00 ! 255.50 i 91. 00 i 33.50 5730.00 14400. 00 31 2-,0. 00 y 14280. 00 AGREED TO AND RECEIVED BY CUSTOMER •-=� .rte; DEL. CHARGE WEIGHMASTER CERTIFICATE THIS IS TO CERTIFY that the following described commodity was weighed, measured, or counted by a weighmaster, whose signature is on this certificate, who is a recognized authority. of accuracy, as prescribed by Chapter 7 (commencing with Section 12710) of Division 5 of the California Business and Professions Code, administered by the Division of Measurement Standards of the California Department of Food and Agriculture. Davi EIGWNIASTER � BY DEPUTY DELIVERY TICKET TAX PREVIOUS BALANCE SUB TOTAL STAND BY CHARGE TOTAL THIS IIS'�NOOTA nCKVF7 NO. ,��,TT NOUMBEOR dn.3894 ®�G� 1111111111 �OPEN 7 DAYSP.O.BOX3600,CORONA,CA92878�600 14� �I illi IIIA 1�Ili Phone 800/834-7557 San Diego 800/870-12M • % 10105693894* #1 RIVERSIDE - 6120 201ti. ST. # 8 SUN CITY - 27050 WATSON RD. #15 VERNON-LOS ANGELES - 3365 E. 26TH ST #22 NO. HOLLYWOOD - 13132 RHYMER STREET#29 EL CAJON - 215 CYPRESS LANE #2 MORENO VALLEY - 12890 DAY ST. # 9 ARROWHEAD - 29750, HWY 18 #16 ANAHEIM - 201 E. COMMERCIAL ST. #23 PARAMOUNT - 7277 E. ROSECRANS AVE. #30 CORONA - 1540 SHERBORN ST. #3 REDLANDS - 8353 ALABAMA ST. #10 SANTA FE SPRGS - 12311 GREENSTONE AVE. #17 SANTA ANA - 310 N. TOWNSEND ST. #24 RIALTO - 2601 N. ALDER AVE. #31 HESPERIA - 9661 C AVENUE #4' FONTANA - 13792 SLOVER AVE. #11 CABAZON - 13990 APACHE TRAIL. #18 LAKE FOREST - 25931 TOWNE CENTRE DR. #25 GARDENA - 301 W. ROSECRANS AVE. #32 UPLAND - 1975 N. BENSON #5 POMONA - 2470 POMONA BLVD. #12 SAN BERNARDINO - 1955 W. 9TH ST. #19 ADELANTO - 12203 VIOLET RD. #26 THOUSAND PALMS -72460 VARNER ROAD #33 MIRAMAR- 5692 EASTGATE DRIVE #6 HEMETISAN JACINTO - 1675 STATE ST. #13 IRWINDALE - 13631 LIVE OAK LANE #20 SAN CLEMENTE - 116 RINCON CT. #27 MURRIETA - 26190 ADAMS AVE. #34 LUCERNE- 36555 HWY 18 #7 BEAUMONT - 452 W. WIS ESTRADA RD. #14 PASADENA - 1420 N. LINCOLN AVE. #21 IRVINE - 16081 CONSTRUCTION CIR. WEST #28 OTAY MESA - 7961 AIRWAY ROAD #35 BIG BEAR LAKE - 42040 BIG BEAR BLVD. - 1 PLANT DATE CUSTOMER NO: SOLD TO: i:'E., 1 1 /�: 8 0 7 TjT99,)�. ?-,()L.JTH COAST CONSTRUCTION 9'4?IGF3 TICK�)V�O 894 TX CD DEL VERY ADDRESS & INSTRUC IONS ( CUSTOMER P.O. / JOB_OR LOT # r� rt .; 11L;HWr4 111 tJ26181+ ti J.l.�r KOMAR DESERT CENTER LA Gill I NTA ( 951) 3 1--7777LAST TKS 15 :-.' Job Phone - .(951 ) 7•74--0173 ORDER f41READ METER fI11�1 TIMETYP�ED' NRhKIUC NO. LOAD NO., SLUMP . TRUCK DR VER �. ��� 299 :.:Iri 1.7 REYES RICHARD CUF'.D&GUl"TERCHAND FOR DRUM JOB START' 7 o 00 c. S REVS: Job -site Cylinder Test: Yes TO JOB _ TIME ON JOB MIN. CHECK # . ON JOB '1 Water added on job at STAND BY MIN. CHECK El Custom7�er's request: AMOUNT BY START POUR / 1 w gals to Full Ld. - RATE of x $ PER MIN. CASH ❑ AMOUNT BY FINISH POUR gals t0 2/3 Ld. gals t0 1/3 Ld. $ OVERTIME CHARGEE PLANT MGR SIG HA LEAVE JOB ADJ. Meter' .1 •t N 4 min. per yd. unloading time allowed. ARRIVE PLANT Additional water added to this concrete will reduce its strength. Any Additional unloading time charged at current hourly truck rate Water added exceeding the design water is at the customer's own risk. TERMS AND CONDITIONS OF SALE In consideratidn of faobertson'sdel vering the descr bed material to place designated by the Customer, the Customer herreleases and agrees to indemnify and hold harmless Robertson's and its employees from all liability or cla ms for damage done by them, resulting from the movement of Robertson's vehicles upon or about the delivery location. Customer acknowledges that the described mater al has been chosen and selected solety by Customer without Robertson's hav ng reviewed any plans or specifications relating to the project on which the material is to be used. Customer agrees to defend, indemnify, and hold Robertson's harmless from all liability or cla ms for damage relating to said matenal being inappropriate, incompatible, improper or inconsistent with plans and specifications, or w th the ground soils or conditions on the land where the material is utilized, to the fullest extent permitted by law. In event Robertson's retains the sere ces of an attorney to collect payment for the described materials; the Customer agrees to pay reasonable attorney's fee's incurred by Robertson's. Customer agrees to pay a time price differential of t Y2%per month on any amounts owed to Robertson's for more than thirty (30) days. LD QTY CUM QTY ORD QTY PROD CODE MIX AND COMMODITY UOM UNIT PR AMT I r i • WATER ALLOWED 380.00 DEL. CHARGE WATER BATCHED 240.50 , - . IY10I S"1 URC WATER 10 i:. 1-41VIWEIGHMASTER CERTIFICATE TAX 1 THIS IS TO CERTIFY that the following described commodity was weighed, MAX ALD WATER 7 . �. � measured, or counted byte weighmaster, whose signature is on this certificate, PREVIOUS cwho is a recognized authority of accuracy, as prescribed by Chapter 7 CEMENT _MEN # 5u5610.. 00 (commencing with Section 12700) of Division 5 of the California Business and BALANCE FINE A G G # 14440. 00 Professions Code, administered by the Division of Measurement Standards of the California Department of Food and Agriculture. SUB 3/8 AGG # 3080..00 DavjFdBERTSON'S,LT TOTAL 1 " AG(3 # .14280. 012A k WEIGHMASTER STAND BY CHARGE BY DEPUTY TOTAL AGREED TO AND RECEIVED BY CUSTOMER DELIVERY'TICKET 6 b Corporate: •�' San Diego/Imperial Cout 2992 E. La Palma Ave. Ste. A 7313 Carroll Rd. Ste. G Anaheim, CA 92806 San Diego, CA 92121 Tel: 714.632.2999 Tel: 858.537.3999 Fax: 714.632.2974 Fax: 858.537.3990 www.mtglinc.coom Dispatch: 800.491.2990 Dispatch: 888.844.5060 MTGLProject#:�[�C1� DAILY INSPECTION Permit #�)_7 ' a �� REPORT Report # PG OF Inland Empire: 14467 Meridian Pkwy., Bldg. 2-A Riverside, CA 92518 Tel: 951.653.4999 Fax: 951.653.4666 Dispatch: 800.491.2990 DSA/CITY File #: DSA/OSHPD APPL #: DSA / LEA #: Special Inspection Reports must be distributed to the parties listed below within 14 days of the inspection. Reports of non-compliant conditions must be distributed immediately. Separate reports shall be prepared for each type of special inspection, on a daily basis. Each report shall be completed and signed by the special inspector conducting the inspection. PROJEC N E GATE ARCHITECT TIME ARRIVED TIME DEPARTED ENGINEER TRAVELJ5L LUNCHTIME CONTRA SUB Co CTOR INSPECTIO F§S ADDRESS OF PROJECT ' TYPE OF INSPECTION BATCH PLANT ❑ ENGINEERED FILL ❑ PT CONCRETE ❑ FOUNDATION ❑ SHOTCRETE ❑ BACK FILL ❑ CONCRETE ❑ MASONRY ❑ HIGH STRENGTH BOLTING ❑ WELDING ❑ SHOP WELD O FIREPROOFING ❑ ANCHOR/DOWEL ❑ NDE FIELD ❑ NDE SHOP ❑ CEILING WIRE ❑ ❑ ❑ DSA/OSHPD/PROJECT: AVAILABLE: APPROVED DOCUMENTS: APPROVED PLANS Y O N ❑ SOIL REPORT Y ❑ N ❑ SPECS: Y ❑ N ❑ APPROVED SHOP DRAWING Y ❑ N ❑ MATERIALS UJMY CONTRACTOR(INCLUD ESEARCH REPORT 0. R MATERIAL TEST R PORTS): CONTRACTORS EQUIPMENT I MANPOWER USED: AREA, GRID LINES, PIECES INSPECTED: Q v STRUCTURAL NOTES, DETAIL, OR RFIS USED: REMARKS, INCLUDING MEETINGS. REWORK AS PE CENT OF ALL WORK TODAY: PERCENT PROJECT COMPLETE: THE WORK WAS k' WAS NOT❑ THE WORK INSPECTED MET❑ DID NOT MEET❑ Inspected in accordance with the requirements of the DSA/OSHPD/PROJECT THE requirementsof he DSA/OS PD/PROJ T approyo docume s. approved documents. Samples taken: C;e_pt 14 MATERIAL SAMPLING WAS WAS NOT 11 N/A 11Weather: Performed in accordance with DSA/OSHPD/PROJECT approved documents. cc Project Architect Contractor ignature cial Inspect Structural Engineer Building Department sp DSA Regional Office Owner Print Name School District Certification #:A-cl Verified by: A177MCorporate: , 2992 E. La Pale�'Ste. A Anaheim, 92 Tel: 714.632.2.29999 Fax: 714.632.2974 www.mtglinc.com Dispatch: 800.491.2990 MTGLProject#• ZpT3 Fit ?nom 4 ' San Diego/Imperial Co' 7313 Carroll Rd. Ste. G San Diego, CA 92121 Tel: 858.537.3999 Fax: 858.537.3990 Dispatch: 888.844.5060 ('� ' DAILY INSPECTION Permit # ot77-- XA REPORT 'Inland Empire: ,14467 Meridian Pkwy., Bldg. 2-A `Riverside, CA 92518 Tel: 951.653.4999 Fax: 951.653.4666 Dispatch: 800.491.2990 DSA/CITY File #: DSA/OSHPD APPL #: r Report # PG OF DSA / LEA #: Special Inspection Reports must be distributed to the parties listed below within 14 days of the inspection. Reports of non-compliant conditions must be distributed immediately. Separate reports shall be prepared for each type of special inspection, on a daily basis. Each report shall be comDleted and sioned by the soecial inspector Conductina the inspection. PROJECTN ME n � \kkNk le NAPA . DATE s ARCHITECT`� " 1 _ TIME ARRIVED TIME DEPARTED ENGINEER" TRAVEL�JuIE LUNCH_ TIME CONTRAC� R - '�� V 1o1 ! SUB CO��ACTOe � • � �� INSPECECTTIION'ADORESS [ ;( ��^��{{ e�• 4 i O `� U lit akl t ADDRESS OF PROJECT ' ^�� p r/ \1 k le '❑ TYPE OF INSPECTION & BATCH PLANT ❑ ENGINEERED FILL ❑ PT CONCRETE ❑ FOUNDATION ❑ SHOTCRETE ❑ BACK FILL ❑ CONCRETE ❑ MASONRY ❑ FIREPROOFING ❑ HIGH STRENGTH BOLTING ❑ ANCHOR/DOWEL ❑ WELDING ❑ NDE FIELD ❑ SHOP WELD ❑ NDE SHOP CEILING WIRE ❑ ❑ . ❑ OSA/OSHPD/PROJECT: AVAILABLE: SOIL REPORT Y NO SPECS: Y❑ NO APPROVED DOCUMENTS: APPROVED PLANS Y ❑ N ❑ APPROVED SHOP DRAWING Y ❑ N ❑ MATERIALS USED-�Y CONTRACTOR (INCLUD RESEARCH REPORT NO. OR MATERIAL TEST REPORTS): >. a CONTRACTORS EQUIPMENT/ MANPOWER USED: AREA, GRID LINES, PIECES INSPECTED: //'�� �j t1 t.L -(71 , ti �y \ ►'S\_ til . l_ k - . (^ �w 0 c) [ l l ►� r% -C- AA _ � l� 'E! STRUCTURAL NOTES, DETAIL, OR RAS USED: REMARKS, INCLUDING MEETINGS: REWORK AS PERCENT OF ALL WORK TODAY: PERCENT PROJECT COMPLETE: THE WORK WAS CIV WAS NOT ❑ Inspected. in accordance with the requirements of the DSA/OSHPD/PROJECT approved documents. MATERIAL SAMPLING WAS ]JWAS NOT ❑ N/A ❑ Performed in accordance with DSA/OSHPD/PROJECT approved documents. cc Project Architect Contractor Structural Engineer Building Department DSA Regional Office Owner School District THE WORK INSPECTED MET ❑ DID NOT MEET ❑ THE requirements of the DSA/PD/PR_OJECT apprl Samples taken: / c::;�C 4 Weather: r71A ki/. Tem -M 1 gnature Certification #: f r k Verified by: THIS IS NOT A TICKET NO. WS COOL 569-3852 - OPEN 7 DAYS I � � l llllll �� 11 I Alli I I I lull 11 I I 111 1111 P.O. BOX 3600, CORONA, CA92878-3600 if. R ., Phone 800/8347557 San Diego 800/870-1220 s z10105693852* RIVERSIDE 6120 #1 - 201h. ST.# 8 SUN CITY - 27050 WATSON RD. #15 VERNON-LOS ANGELES - 3365 E. 26TH ST. #22 NO. HOLLYWOOD - 13132 RAYMER STREET#29 EL CAJON - 215 CYPRESS LANE #2 MORENO VALLEY - 12890 DAY SL # 9 ARROWHEAD - 29750 HWY 18 #16 ANAHEIM , 201 E. COMMERCIAL ST. - #23 PARAMOUNT - 7277 E. ROSECRANS AVE. #30 CORONA - 1540 SHERBORN ST. #3 REDLANDS - 8353 ALABAMA ST #10 SAMA FE SPRGS - 12311 GREENSTONE AVE. #17 SAMA ANA -.310 N. TOWNSEND ST. #24 RIALTO - 2601 N. ALDER AVE. #31 HESPERIA - 9661 C AVENUE #4 FONTANA - 13792 SLOVER AVE #11 CABAZON - 13990 APACHE TRAIL. #18 LAKE FOREST - 25931 TOWNE CENTRE DR. #25 GARDENA - 301 W. ROSECRANS AVE. #32 UPLAND - 1975 N. BENSON #5 POMONA - 2470 POMONA BLVD. #12 SAN BERNARDINO - 1955 W. 9TH ST. #19 ADELANTO -•12203 VIOLET RD. #2E THOUSAND PALMS -72460 VARNER ROAD #33 MIRAMAR- 5692 EASTGATE DONE #6 HEMET/SAN JACINTO - 1675 STATE ST #13 IRWINDALE - 13631 WE OAK LANE #20 SAN CLEMENTE - 116 RINCON CT #27 MURRIETA - 26190 ADAMS AVE. #34 LUCERNE- 36555 HWY 18 #7 BEAUMONT - 452 W. WIS ESTRADA RD. #14 PASADENA - 1420 N. LINCOLN AVE. #21 IRVINE - 16081 CONSTRUCTION CIR. WEST #28 OTAY MESA - 7961 AIRWAY ROAD #35 BIG BEAR LAKE - 42040 BIG BEAR BLVD. PLANT DATE CUSTOMER NO: SOLD TO: MAP PAGE TICKET NO. 26 11/27/07 58801 SOUTH COAST -CONSTRUCTION 849J3 .5693852 TX CD DEUVERY ADDRESS & INSTRUCTIONS CUSTOMER P.O. / JOB OR LOT # 79793 HIGHWAY 111- E2642 1516 KOMAR DESERT CENTER L-A QUINTA (951)351--77771-AST TKS 150 Job Phone : (951) 351--77*7.7 ORDER NO. METER READING TIME TYPED TRUCK UC NO. 447. 1600.00 6:40 NEED LOAD NO. SLUMP TRUCK DRIVER =` ? 4.00 454 133 MCKINNON JOHN CURB&GUTTERCHAND FOR DRUM !^ .JOB START 7:00 �lJ j REVS: Job -site Cylinder Test: 0 Yes I ~ TO JOB TIME ON JOB MIN. i CHECK ON JOB D /q. Water added on job at 1+ r Customer's request: STAND BY MIN. CHECK ❑, r AMOUNT BY START POUR I gals to Full Ld� ` RATE OF X $ PER MIN. CASH 'El Err FINISH POUR U gals to 2/3 Ld.$ PLANT MGR SIG' gals to 1/3 Ld..-?. OVERTIME CHATTGE LEAVE JOB ADJ. Meter4 MIN. 4 min. per yd. unloading time allowed. ARRIVE PLANT Additional water added to this concrete will reduce its strength.Any Additional unloading time charged at current hourly truck rate r he customer's own risk: water added exceeding the design water is at t s TERMS AND CONDITIONS OF SALE In consideration of Robertson's delivering the described material to a place designated by the Customer, the Customer hereby releases and agrees to indemnify and hold harmless Robertson's and its employees from all liability or claims for damagad neby them, ra in g from the movement of Robertson's vehicles upon or about the delivery location. Customer acknowledges that the the material has been chosen and selected solely by Customer w shout Robertson's having rev awed any plans or specifications relating to the project on which the material is to be used. Customer agrees to defend, indemnify, and hold Robertson's harmless from all liability or clams for damage relating to sold materlat being inappropriate, incompatible, improper or inconsistent with plans and specifications, or with the ground sods or conditions on the land where the material is util zed, to the fullest extent permitted bylaw. In event Robertson's retains the services of an attorney to collect payment for the described materials, the Customer agrees to pay reasonable attorney's fee's incurred by Robertson's. Customer agrees to pay a time pr ce differential of 1 %z%per month on any amounts owed to Robertson's for more than thirty (30) days. LD QTY CUM QTY ORD QTY PROD CODE MIX AND COMMODITY UOM UNIT PR AMT 10.00 20.00 20.r00 BC56OB31 56OC325O CY r -; M � WATER'ALLOWED 380.00 w WATER BATCHED :30.00 r MOISTURE WATER, 129.00 MAX ADD WATER 21.00 CEMENT # 5550.00 /8 AGG,. # 3080.00 ill AGG " # 14200. 00 .� W SAND $t 14600.00 /'1 Q 5v1 �,/��,-57- AGREED TO AND RECEIVED BY CUSTOMER DEL. CHARGE WEIGHMASTER CERTIFICATE THIS IS TO CERTIFY that the following described commodity was weighed, measured, or counted by a weighmaster, whose 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 California Business and Professions Code;' administered by the Division of Measurement Standards of the California Department of Food and Agriculture. " D a v lRdBEFLTSON'S, 0 WEIGHMASTER BY DEPUTY TAX PREVIOUS BALANCE SUB TOTAL STAND BY CHARGE " - I TOTAL DELIVERY TICKET THIS IS NOT A TICKET NO. CONTROL NUMBER WK2 � OPEN 7 DAYS h P.O. BOX 3600, CORONA, CA 92878-3600 Phone 800/8347557 San Diego 800/870-1220 *10105693852* .4 #1 RIVERSIDE - 6120 20th. ST. # 8 SUN CITY - 27050 WATSON RD. #15 VERNON-LOS ANGELES - 3365 E. 26TH ST. #22 NO. HOLLYWOOD - 13132 RAYMER STREET #29 EL CAION - 215 CYPRESS LANE #2 MORENO VALLEY - 12890 DAY ST. # 9ARROWHEAD - 29750 HWY 18 #16 ANAHEIM - 201 E. COMMERCIAL ST. #23 PARAMOUNT - 7277 E. ROSECRANS AVE. #30 CORONA - 1540 SHERBORN ST. #3 REDLANDS - 8353 ALABAMA ST #10 SANTA FE SPRGS - 12311 GREENSTONE AVE. #17 SAMA ANA -'310 N. TOWNSEND ST. #24 RIALTO - 2601 N. ALDER AVE. #31 HESPERIA - 9661 C AVENUE #4FONTANA- 13792 SLOVER AVE. #11 CABAZON - 13990 APACHE'TRAIL. #18 LAKE FOREST, 25931 TOWNE CENTRE DR. #5 POMONA - 2470 POMONA BLVD. #12 SAN BERNARDINO - 1955 W. 9TH ST. ' #19, ADELANTO12203 VIOLET RD. #25 GARDENA - 301 W. ROSECRANS AVE. #32 UPLAND - 1975 N. BENSON #26 THOUSAND PALMS -72460 VARNER ROAD #33 MIRAMAR- 5692 EASTGATE DRIVE #6 HEMET/SAN JACINTO - 1675 STATE ST. #13 IRWINDALE - 13631 LIVE OAK LANE #20 SAN CLEMENTE - 116 RINCON CT. #27 MURRIETA - 26190 ADAMS AVE. #34 LUCERNE- 36555 HWY 18 #7 BEAUMONT - 452 W. LUIS ESTRADA RD. #14 PASADENA - 1420 N. LINCOLN AVE. #21 IRVINE - 16081 CONSTRUCTION CIN. WEST #28 OTAY MESA - 7961 AIRWAY ROAD #35 BIG BEAR LAKE - 42040 BIG BEAR BLVD. PLANT DATE CUSTOMER NO: SOLD TO:�' MAP PAGE TICKET NO. 21 E. 11/27/07 ` 8801 SDU n -i CDAS rCONSTRUC) ION 849J3 5693852 TX CD DELIVERY ADDRESS & INSTRUCTIONS a CUSTOMER PO. / JOB OR LOT # 79793 HIGHWAY 1 1 1 � 64 1516 26 ' KOMAR DESERT CENTER LA DC. 1 NTA � -<951 ) _,51--7777L_.AS'(' TKS 150 Job Phone : (`. 51) 301-777'7 "" ORDER NO. METER READING TIME TYPED TRUCK UC NOi, R 4.47 1600. 00 • , 6 i40 NEED _ r LOAD NO. SLUMP TRUCK DRIVER 2 t+. V.+vl 454- _ ;1 33 MCK Z NN(.7N JOHN CURB&GILI TE -R EHAND FOR / J[7E+ _(..AFS% 7 • (A(A , l,, J DRUM' TO JOB ( 43 t, REVS: Jobsite Cylinder Test,: ❑Yes TIME ON JOB MIN. CHECk # ON JOB —I Water added on job at STAND BY MIN. CHECK El^1 Customer's request: r-, - AMOUNT BY START POUR gals to Full Cd! .;(~ RATE OF X$ PER MIN. CASH AMOUNT BY FINISH POUR "T gals to 2/3 Ld. Y$ PLANT MGR SIG gals to 1/3 Ldp;.,- OVERTIME CHARGE LEAVE JOB ADJ. Meterl M T N 4 min. per yd. unloading time allowed. ARRIVE PLANT Additional water addedlothis concrete will reduce its strength. Any Additional unloading time charged at current hourly truck rate water added exceeding the design water is at the customer's own Irisk. TERMS AND CONDITIONS OF SALE In consideration of Robertson's delivering the described material to a place designated by the Customer, the Customer herreleases and agrees to indemnify and hold harmless Robertson's and its employees hom all liability or claims for damage done by them, resulting from the movement of Robertson's vehicles upon or about the delivery location. Customer acknowledges that the described material'has been chosen and selected solely by Custorr00er without Robertson's having reviewed any plans or specifications relating to the project on which the material is to be used. Customer agrees to defend, indemnify, and hold Robertson's harmless }foTrl all liability or claims for damage relating to said matenal being inappropriate, incompatible, improper or inconsistent with plans and specifications, or with the ground soils or conditions on the land where the material is utilized, to the fullest extent permitted by law. In event Robertson's retains the sere ces of an attorney to collect payment for the described materials; the Customer agrees to pay reasonable attorney's fee's incurred by Robertson's. Customer agrees to pay a time price differential of 1 Yz%per month on any amounts owed to Robertsons for more than thirty (30) days. LD QTY CUM QTY ORD QTY PROD CODE MIX AND,COMMODITY UOM UNIT PR /. AMT 10,.po c0. Q7.J 2QQ, 0-_(3(- `66P31 5E WATER ALLOWED 380.0.0 I WATER �BAT'CHE D k2`30'. 0121.1'J MOISTURE WATER 129.00 MAX ADD WATER 21. 00 r. c•-5 3/8 AGG'< < # ,SCA80. 00 ill AG G # •'14200. 00 _ .s sad W SAND # • 14600.00 AGREED TO AND RECEIVED BY CUSTOMER ";0 CY -. r y.+ DEL. CHARGE r WEIGHMASTER CERTIFICATE THIS IS TO' CERTIFY that the following described commodity was weighed, measured, or counted by a weighmaster, whose 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 California Business and Professions Code,,administered by the Division of Measurement Standards of the California Deparrtrrr(ent of F6od and Agriculture. t Da V ]ROBERTSON'S Z1?. - f WEIGHMASTER BY DEPUTY r h TAX PREVIOUS a BALANCE SUB " TOTAL' STAND BY CHARGE j TOTAL �� 1 Cyt 1 �. '-�..�.,i � � 1 :: •,� DELIVERY TICKET