HomeMy WebLinkAboutWTR2703604_3CITY OF RENTON PUBLIC WORKS DEPARTMENT
WATER UTILITY ENGINEERING
WATER MAIN PRESSURE TEST AND PURIFICATION TEST FORM
PROJECT NO. 51
NAME OF PROJECT 4� 9. � � • L�P�a, MAiv � ln► c�t1C�� �%S � i
PRESSURE TEST WITNESSED BY
1
AT TEST PRESSURE OF 7l) PSI
TEST ACCEPTED ON
PURIFICATION TEST TAKEN BY G �IN C HA M
PURIFICATION TEST RESULTS
SAMPLE #1
SAMPLE #2
SAMPLE #3
SAMPLE #4
SAMPLE #5
REMARKS LM� A t t Z
FOR t
ON V+1 12-
SATISFACTORY LAB SAMPLE NO
YES NO
Sic z q 1 t
MINUTES
Date
CITY OF RENTON PUBLIC WORKS DEPARTMENT
WATER UTILITY ENGINEERING
WATER MAIN PRESSURE TEST AND PURIFICATION TEST FORM
PROJECT NO. % , S 551
NAME OF PROJECT S� �� A,C, aYe/hjn V%c(coneAy
PRESSURE TEST WITNESSED BY
AT TEST PRESSURE OF 230 PSI FOR i2O MINUTES
TEST ACCEPTED ON 8/ Vl 12-
PURIFICATION TEST TAKEN BY Az=h*-,—, ON 23 `o �Il
PURIFICATION TEST RESULTS SATISFACTORY LAB SAMPLE NO. Date
YES NO
SAMPLE #1
SAMPLE #2
SAMPLE #3
SAMPLE #4
SAMPLE #5
REMARKS
S S1- Hihonk e SkIL. 62A-40
0660 W q g116112
0660 UR 5- X/I61►2
AST AmTest Laboratories
`"' ° .." -1° "' 1-. COLIFORM BACTERIA ANALYSIS
Date Sample Collected
Time Sample
County:
08/15/2012
Collected m AM
Month Day Year
9:10 ❑ PM
KING
Type of Water System (check only one box)
Q Group A Public ❑ Private Household
❑ Group B Public ❑ Other.
Group A and Group B Systems Provide from Water Facilities Inventory (WFI):
IN 71850L
System Name: CITY OF RENTON
Contact Person: ABDOUL GAFOUR
Day Phone: 425 430 7210 Cell Phone:
Eve. Phone: FAX:
Send results to: (Print full name, address and zip code)
CITY OF RENTON WATER UTILITY
ABDOULGAFOUR
1055 S GRADY WAY
RENTON, WA, 98057
SAMPLE INFORMATION
Sample collected b (name): S PINKHAM
Specific location where sample collected:
SE 5TH ACWM FH STA 62+40
Special Instructions or Comments: WTR-27-3551
Type of Sample (must check only one box of #1 through #4 listed below)
1. ❑ Routine Distribution Sample
2. ❑ Repeat Sample (after unsat. routine)
❑ Distribution System
Chlorinated: ❑ Yes ❑ No
❑ Source Groundwater Rule (GWR)
Chlorine Residual: Total Free_
(Population of 1,000 or less)
3. Raw Water Source Sample
❑ E. coli - GWR source sample
Unsatisfactory routine lab number:
❑ Fecal - Surface, GWI, some springs
❑ Other
Unsatisfactory routine collect date:
Chlorinated: Yes No
Public Systems must provide Source Number from (MI)
Chlorine Resid: Total Free
4. ® Sample Collected for Information Only
0 Construction ❑ Repairs ❑ Private Residence ❑ Other
LAB USE ONLY DRINKING WATER RESULTS LAB USE ONLY
❑ Unsatisfactory Z Satisfactory
Total Coliform Present and
❑ E. coli present ❑ E. coli absent
❑ Fecal coliform present ❑ Fecal coliform absent
❑ Replacement Sample Required
Sample not tested because Test unsuitable because:
❑ Sample too old (>30 hours) ❑ TNTC
❑ Improper Container ❑ Turbid Culture
❑ ❑
Bacterial Density Results: Plate Count I mi. E.coli /100 mi.
Total Coliform < 1 /100 mi. Fecal Coliform < 1 /100 mi.
Method Code:
Date and Time Received:
MICR- 2810
8/15/2012,14:40
Date Analyzed:
Date Reported: 8/16/12
06602894
Lab Use Only:
Sample Number (DOH number plus five digits)
DOH Form #331-319 (revised a/05)
PMEST AmTest Laboratories
` " " ' " ' ' ..................... " " COLIFORM BACTERIA ANALYSIS
Date Sample Collected
Time Sample
County:
08/15/2012
Collected 0AM
Month Day Year
9:15 11 PM
KING
Type of Water System (check only one box)
0 Group A Public ❑ Private Household
❑ Group B Public ❑ Other:
Group A and Group B Systems Provide from Water Facilities Inventory (WFI):
IN 71850L
system Name: CITY OF RENTON
Contact Person: ABDOUL GAFOUR
Day Phone: 425 430 7210
Cell Phone:
Eve. Phone:
FAX:
Send results to: (Print full name, address and zip code)
CITY OF RENTON WATER UTILITY
ABDOULGAFOUR
1055 S GRADY WAY
RENTON, WA, 98057
SAMPLE INFORMATION
Sample collected b (name): S PINKHAM
Specific location where sample collected:
SE 5TH ACWM TEMP BO SE 6TH/5TH
Special Instructions or Comments: WTR-27-3551
Type of Sample (must check only one box of #1 through #4 listed below)
1. ❑ Routine Distribution Sample
2. ❑ Repeat Sample (after unsat. routine)
❑ Distribution System
Chlorinated: ❑ Yes ❑ No
❑ Source Groundwater Rule (GWR)
Chlorine Residual: Total Free_
(Population of 1,000 or less)
3. Raw Water Source Sample
❑ E. coli - GWR source sample
Unsatisfactory routine lab number:
❑ Fecal - Surface, GWI, some springs
❑ Other
— --
Unsatisfactory routine collect date:
N
Chlorinated: Yes o
Public Systems must provide Source Number from (WFI)
Chlorine Resid: Total Free
4. 0 Sample Collected for Information Only
0 Construction ❑ Repairs ❑ Private Residence ❑ Other
LAB USE ONLY DRINKING WATER RESULTS LAB USE ONLY
❑ Unsatisfactory 0 Satisfactory
Total Coliform Present and
❑ E. coli present ❑ E. coli absent
❑ Fecal coliform present ❑ Fecal coliform absent
❑ Replacement Sample Required
Sample not tested because Test unsuitable because:
❑ Sample too old (>30 hours) ❑ TNTC
❑ Improper Container ❑ Turbid Culture
❑ ❑
Bacterial Density Results: Plate Count I mi. E.coli I100 mi.
Total Coliform < 1 1100 mi. Fecal Coliform < 1 1100 mi.
Method Code:
Date and Time Received:
MICR- 2810
8/1512012,14:40
Date Analyzed:
Date Reported:
06602895
Lab Use Only:
77�:d
Sample Number (DOH number plus five digits)
DOH Form #331-319 (revised 8105)
PmEST AmTest Laboratories
` " " " " " ' ° " ' .. COLIFORM BACTERIA ANALYSIS
Date Sample Collected
Time Sample
County:
08/07/2012
Collected 0 AM
Month Day Year
9:35 ❑ PM
KING
Type of Water System (check only one box)
0 Group A Public ❑ Private Household
❑ Group B Public ❑ Other.
Group A and Group B Systems Provide from Water Facilities Inventory (WFI):
IN 71850L
System Name: CITY OF RENTON
Contact Person: ABDOUL GAFOUR
Day Phone: 425 430 7210
Cell Phone:
Eve. Phone:
FAX:
Send results to: (Print full name, address and zip code)
CITY OF RENTON WATER UTILITY
ABDOULGAFOUR
1055 S GRADY WAY
RENTON, WA, 98057
SAMPLE INFORMATION
Sample collected b (name): S PINKHAM
Specific location where sample collected:
Special Instructions or Comments: Email
Type of Sample (must check only one box of #1 through #4 listed below)
1. ❑ Routine Distribution Sample
2. ❑ Repeat Sample (after unsat. routine)
❑ Distribution System
Chlorinated: ❑ Yes ❑ No
❑ Source Groundwater Rule (GWR)
Chlorine Residual: Total Free
(Population of 1,000 or less)
3. Raw Water Source Sample
❑ E. coli - GWR source sample
Unsatisfactory routine lab number:
❑ Fecal - Surface, GWI, some springs
❑ Other
— --
Unsatisfactory routine collect dale:
Chlorinated: Yes No
Public Systems must provide Source Number from (WFI)
Chlorine Resid: Total Free
4.0 Sample Collected for Information Only
0 Construction ❑ Repairs ❑ Private Residence ❑ Other
LAB USE ONLY DRINKING WATER RESULTS LAB USE ONLY
❑ Unsatisfactory Z Satisfactory
Total Coliform Present and
❑ E. soli present ❑ E. coli absent
❑ Fecal col'lform present ❑ Fecal col'lform absent
❑ Replacement Sample Required
Sample not tested because Test unsuitable because:
❑ Sample too old (>30 hours) ❑ TNTC
❑ Improper Container ❑ Turbid Culture
❑ ❑
Bacterial Density Results: Plate Count 1 mi. E.coli 1100 mi.
Total Coliform < 1 1100 mi. Fecal Coliform < 1 1100 mi.
Method Code:
Date and Time Received:
MICR- 2810
8/ 7/2012, 14:30
Date Analyzed:
Date Reported: 8/ 8/12
06602762
Lab Use Only:
Sample Number (DOH number plus five dighs)
DOH Form #331-319 (revised 8105)
DAILY INSPECTION DIARY
J
DAY: DATE: / / WORK PERIOD: a.m./p.m. to
WEATHER: TEMP. MAX OF MIN OF PRECIPITATION:
WORK ACCOMPLISHED TODAY:
CONTRACTOR SIGNATURE
a.m./p.m.
SIGNATURE
REPORT 4�
DATE:
DAILY INSPECTION DIARY
REPORT 4�
DAY: DATE: WORK PERIOD a.m./p.m. to �� a.m./p.m.
WEATHER: TEMP. MAX -F MIN, °F PRECIPITATION:
WORK ACCOMPLISHED TODAY:
CONTRACTOR SIGNATURE
INSPECTOR SIGNATURE
DATE:
DAILY INSPECTION DIARY
REPORT 4f
DAY: DATE: 2 /Z74Z, WORK PERIOD: a.m./p.m. to a.m./p.m.
WEATHER: ��. TEMP. MAX "7-'--5—°F MIN °F PRECIPITATION:
WORK ACCOMPLISHED TODAY:
CONTRACTOR SIGNATURE INSPECTOR SIGNATURE
DATE:
DAILY INSPECTION DIARY
REPORT
DAY: DATE: / / WORK PERIOD:��/p.m. to a.m./p.m.
S
WEATHER: TEMP. MAX OF MIN OF PRECIPITATION:
WORK ACCOMPLISHED TODAY:
CONTRACTOR SIGNATURE
INS ECTOR SIGNATURE
DATE:
DAILY INSPECTION DIARY
REPORT �l
DAY: '77,.,,:�DATE: / WORK PERIOD: Da-m-p.m. to a.m./p.m.
WEATHER://�aTENP. MAX OF MIN OF PRECIPITATION: AZC- z 6
WORK ACCOMPLISHE TODAY:
CONTRACTOR SIGNATURE
INSPECTOR SIGNA
DATE:
DAILY INSPECTION DIARY
REPORT
DAY: DATE: k,-J3 WORK PERIOD: a.m./p.m. to a.m./p.m.
WEATHER: TEMP. MAX MINF PRECIPITATION:
WORK ACCOMPLISHED TODAY:
i— 4 c; e
CONTRACTOR SIGNATURE
-t�6-ts'
<iF --5p�
INSPECTOR SIGNATURE
DATE:
DAILY INSPECTION DIARY
�., REPORT �f
DAY: DATE: 70 wZWORK PERIOD: a.m./p.m. to a.m./p.m.
WEATHER: TEMP. MAX OF MIN �j "F PRECIPITATION: -
WORK ACCOMPLISHED TODAY:
CONTRACTOR SIGNATURE
rl,4 1/,L-,
INSPECTOR SIGNATURE
"BOOT
DAILY INSPECTION DIARY
DAY: IA114�7� DATE: 76S-Xg-WORK PERIOD: a.m./p.m. to a.m./p.m.
WEATHER: -70'- TEMP. MAX °F MIN _t5j5°F PRECIPITATION:
WORK ACCOMPLISHED TODAY:
�l
0
REPORT
!_ .i' . _ - ,4 P wr r1L. 1 , I d N _ o /I- � d —
CONTRACTOR SIGNATURE
w ) 1--) e,, ,ram_ rf ' x . ,
Z
INSPECTOR SIGNATURE
DATE:
DAILY INSPECTION DIARY
REPORT #
DAY: DATE: WORK PERIOD: a.m./p.m. to a.m./p.m.
WEATHER: TEMP. MAX ,!�!,? °F MIN !2�:`F PRECIPITATION: /y�ff�ii'f
WORK ACCOMPLISHED TODAY:
CONTRACTOR SIGNATURE
SIGNATURE
DATE:
DAILY INSPECTION DIARY
REPORT #
DAY: DATE: /q2 WORK PERIOD: a.m./p.m. to a.m./p.m.
WEATHER: TEMP. MAX OF MIN PRECIPITATION:
WORK ACCOMPLISHED TODAY:
CONTRACTOR SIGNATURE
eop �f -OD—)L (l
wwiAis-4m
SIGNATURE
DATE:
DAILY INSPECTION DIARY
_ 2� REPORT 4l
DAY: DATE: K-0 ORK PERIOD: a.m./p.m. to a.m./p.m.
WEATHER: C.l �� -C TEMP. MAX L� °F MIN F PRECIPITATION:
WORK ACCOMPLISHED TODAY:
CONTRACTOR SIGNATURE INSP CTOR SIGNATURE
DATE:
DAILY INSPECTION DIARY
REPORT �k
DAY: DATE: 7 / WORK PERIOD: a.m./p.m. to a.m./p.m.
WEATHER: �. EMP. MAX °F MIN ,,�°F PRECIPITATION:
WORK ACCOMPLISHED TODAY:
ffl -7, ;F �, ,/7 _� �yn -
„ .. /
4.�� i 1J1�5 , ✓ r .e-,,i , . d rho
fin, r _ q-7z�� ,-� -/.-;2 , ,-,z"- � �t�" ;::? R
CONTRACTOR SIGNATURE
INSPECTOR SIGNATURE
DATE:
DAILY INSPECTION DIARY
REPORT #
DAY: DATE: // 4-;) WORK PERIOD: a.m./p.m. to a.m./p.m.
WEATHER: G TEMP. MAX OF MINAV OF PRECIPITATION:~/>
WORK ACCOMPLIS ED TODAY:
3a,
CONTRACTOR SIGNATURE INSPECTOR SIGNATURE
DATE:
DAILY INSPECTION DIARY
REPORT
DAY: �� DATE:��,�p�.-WORK PERIOD: a.m./p.m. to a.m./p.m.
WEATHER: TEMP. MAX <j°F MIN f3°F PRECIPITATION:
WORK ACCOMPLISHED TODAY:
CONTRACTOR SIGNATURE
l
SIGNATURE
DATE:
DAILY INSPECTION DIARY
DAY: DATE: ZczWORK PERIOD:
WEATHER: c . TEMP. MA}�_R°F MIN r1v OF
WORK ACCOMPLISHED TODAY:
c
a.m./p.m. to
PRECIPITATION:
a.m./p.m.
CONTRACTOR SIGNATURE INSPECTOR SIGNATURE
REPORT #
DATE:
DAILY INSPECTION DIARY
REPORT #
DAY: ���� DATE: / 112YORK PERIOD: a.m./p.m. to a.m./p.m.
WEATHER: �/ ' TEMP. MAX �°F MIN°F PRECIPITATION: JJE�/j
WORK ACCOMPLISHED TODAY:
J
-3 2/
0
CONTRACTOR SIGNATURE INSPEC OR SIGNATURE
DATE:
DAILY INSPECTION DIARY
DAY: �� DATE: R / ` ORK PERIOD: a.m./p.m. to
WEATHER: ��j TEMP. MAX 74!:�,°F MIN OF PRECIPITATION:
WORK ACCOMPLISHED TODAY:
CONTRACTOR SIGNATURE
a.m./p.m.
i
rip
INSPEC R SIGNATURE
REPORT 46
DATE:
DAILY INSPECTION DIARY
REPORT
DAY: DATE: WORK PERIOD: a.m./p.m. to a.m./p.m.
WEATHER: TEMP. MA} "L°F MIN 5�°F PRECIPITATION:`
WORK ACCOMPLISHED TODAY:
CONTRACTOR SIGNATURE IN PECTOR SIGNATURE
DATE:
r
Y
DAILY INSPECTION DIARY
DAY: ��`� DATE: / WORK PERIOD: a.m./p.m. to
WEATHER: TEMP. MAXO_,-;�°F MIN �j��OF PRECIPITATION:
WORK ACCOMPLISHED TODAY:
c
CONTRACTOR SIGNATURE
a.m./p.m.
rr - ,
INSP 0 S GNATURE
REPORT
DATE:
a DELIVERY TICKET
.iEATTLE (Plant #11) 3803 E. Marginal Wy S.. Seattle
T ACCOUNTING (206) 762-2566
TUKWILA (Plant #12) 17024 W. Valley Hwy., Tukwila
CONCRETE RENTON (Plant #14) 915 Houser Way N., Renton FAX (206) 762 2358
ACCOUNTING: 9125 TENTH AVENUE SOUTH CEDAR SHORES (Plant #20) 21010 Cedar Grove Rd. S.E., Maple Valley SALES &
SEATTLE, WA 98108 • (206) 762-2566 A DIVISION OF GARY MERLINO CONSTRUCTION COMPANY, INC. ORDER DESK (425) 226-1000
TICKET TIME AM
LEAVE PLANT
ARRIVE JOB
BEGIN POUR
FINISH POUR,
LEAVE JOB
ARRIVE PLANT
PM
DATE
CUSTOMER NO. ORDER
NO.
PROJECT
PLANT #
CUSTOMER NAME
CUSTOMER P.O.
JOB NO. DELIVERY TICKET NO.
JOB ADDRESS
COLLECT ON DELIVERY (C.O.D.)
[]CASH CHECK # CHARGE
MAP ZONE
CARD # EXR
SPECIAL INSTRUCTIONS
❑ VISA ❑ MASTERCARD DISCOVER
•
�•mill"
DESCRIPTION
•
�
77m'
JOB TOTAL
SLUMP
SPACING
ORDERED BY
•
TRUCK NO.
DRIVER
•
WATER ADDED ON -SITE
CYLINDERS
AUTHORIZED BY:
•
G YES
1:
•
gals. to full load
❑ YES
REASON FOR DELAY TIME:
gals. to 2/3 load
— JOB NOT READY C LACK OF HELP ADDING WATER ❑ WHEEL BARROW JOB
❑ YES
= ARRIVED JOB EARLY ` TRAFFIC TRAIN [I DRAW BRIDGE
gals. to 1 /3 load
—i WAITING FOR TRUCK TO UNLOAD PUMP BLOW -BACK
❑ NONE
❑ WAITING ON PUMP _ WASH PUMP ] OTHER
ADDITION OF WATER WILL REDUCE
- WARNING -
RELEASE — CUSTOMER RELEASES AND AGREES TO HOLD HARMLESS STONEWAY CONCRETE,
RRITATION TO
A DIVISION OF GARY MERLINO CONSTRUCTION COMPANY, INC. FOR ANY DAMAGE TO HIS REAL
STRENGTH. WATER ADDED AT
SKIN AND EYES
OR PERSONAL PROPERTY CAUSED BY DELIVERY OF'MATERIALS LISTED ABOVE, DETAILS OF SITE
CUSTOMER'S OWN RISK.
SEE REVERSE (16)
AGREEMENT ACCESS ON BACK_(5).
6 MINUTES PER CUBIC YARD
NOT RESPONSIBLE
FOR COLOR
CUSTOMER SIGNATURE
UNLOADING TIME INCLUDED.
VARIATION OR
Additional unloading time charged at current hourly truck rate. SURFACE
DISCOLORATION
PRINT NAME DATE
BATCH DATA:
TICKET TOTAL
REV 06/08 NBF CUSTOMER COPY
TERMS, CGNDITIONS AND WARNINGS
1. CREDIT. Condition precedent to Seller's obligation to perform any and all , is dit le ms of payment must beset forth in this Contract. In the absence of any such credit terms, all
deliveries under this Contract are "Collect On Delivery" (C.O.D.). purc! +s+ agreeS upon request to furnish Seller such information as is reasonably necessary for Seller to
determine Purchaser's financial condition. Seller's obligation to pertonii unf.. : it,r, Contract is subject to the condition precedent that Seller shall have thirty (30) days from
receipt of the executed Contract from Purchaser so that Seller's cred-t departn,eilt onay review and approve or disapprove any credit terms of payment specified in this Contract.
2. TERMS OF PAYMENT. All invoices are due for payment by the 30th day altar the dolt;+ of invoice. Service charges of one and one -quarter percent (1.25%) per month will be
payable on all past due invoices of thirty (30) days or older. If a service charg Is ssra; ed, it must be paid in order to maintain art open account. Purchaser shall make all
payments due hereunder in lawful money of the United States and in accordance with the terms hereof. without any retention and without regard to any agreement Purchaser
may have with other parties. Should legal action be Initiated to collect this invoice, the prevailing party shall be entitled to recover reasonable attorney fees and costs, including
appeals, bankruptcies. and post-judgernent collection efforts. Venue and jurisdiction of any Suit or legal action may be had in Seattle, King County, Washington at the sole option
of Seller. This agreement shall be construed and enforced in accordance with the laws of the State of Washington. STONEWAY CONCRETE ROUTINELY EXERCISES THEIR
RIGHT TO SEND MATERIALMAN'S NOTICES ON ALL JOBS.
3. TAXES. All federal. state and local taxes. assessments, fees, duties and charges levied by reason of this Proposal are in addition to prices quoted herein and shall be paid by
Purchaser.
4. SCHEDULING. Changes or variations from original delivery request shall be conveyed through Seller's dispetch office and no other Seller's agent (including, but not limited to,
drivers, quality assurance personnel or sales representativeal.
5. DELIVERY CONDITIONS. All concrete deliveries will be made in concrete transit mixer trucks unless otherwise noted. Signed Purchaser has requested Stoneway Concrete, a
Division of Gary Merlino Construction Company, Inc. (Seller) to make use of a path for the delivery of materials and access to the project requiring trucks to travel beyond the
boundaries of the nearest traveled public highway. Seller has advised that duo to the size and weight of trucks, damage to the premises and/or adjacent property, or personal
injury may occur and that trucks may become damaged, disabled or stuck If Seller makes use: of the path requested. Seller has further advised that it is their policy that deliveries
requiring Seller's trucks travel beyond the nearest highway to obtain access to the job site arc at the risk of the Purchaser and that Seller assumes no liability for property damage
or personal injury that may result. Purchaser agrees to assume responsibility to Seller and third parties for property damage. personal injuries, truck towing and winching
expenses, and/or damage to Seller's trucks should the trucks become damaged, disabled or stunk as a result of Seller making use of the path requested or for the delivery of
materials and access to the project site. Purchaser also agrees to indemnify. hold harmless, and defend Seller from any claims, demands, losses, and liabilities to or by third
parties arising from, resulting from, or connected with the use of the requested path for the delivery of materials whether such claims may prove to be true or false. groundless or
fraudulent, to the full extent permitted by law and subject to the limitations below. Purchaser's duty to indemnify Seller for liability for damages arising out of bodily injury to
persons or damage to property caused by or resulting from the concurrent negligence of (a) Stoneway Concrete, a Division of Gary Merlino Construction Company, Inc. or its
agents and employees, and (b) the Purchaser shall apply only to the extent of the negligence of the Purchaser or its agents and employees. For the purpose of the Purchaser's
indemnification obligation only, the Purchaser specifically and expressly waives any immunity that may be granted it under the Washington State Industrial insurance Act, Title 51
RCW. This waiver does nct permit a direct action by the Purchaser's employees against the Purchaser, Further, the indemnification obligation under this Agreement shall not be
limited In any way by any limitation on the amount or type of damages, compensation or benefits payable to or for any third party under worker's compensation acts, disability
benefit acts, or their employee benefit acts. This promise of indemnity specifically applies in the case of injuries to the undersigned's own employees. The undersigned's duty
to defend, indemnify and hold Seller harmless shall include. as to all claims, demands, losses.. and liability to which it applies, Seller's personnel related costs, reasonable
attorney's fees, court costs, and all other claim -related expenses, including attorney's fees and other costs incurred by Seller to enforce and establish its right under this
Agreement. Upon Seller's tender of defense under this Agreement, the Purchaser agrees to appoint counsel of Seller's choice to defend against third party claim(s). Such
counsel will be at the sole expense of the Purchaser. Seller is not responsible for means and methods of placement of ready mixed concrete or aggregate products on a project.
6. WASH OUT AREA. It will be. the Purchaser's responsibility to provide a suitable area for trucks to rinse arid clean before leaving the job site. An additional charge will be made
per load if a wash out area is not provided.
7. PUMP HOLDS AND BLOWBACK. Seller holds no responsibility or obligation of Communication to Purchaser when Pump Company holds or releases orders. Service to
Purchaser will be done to the best of Seller's ability, noting Purchaser may not receive original rate of pour requested. It is the responsibility of Pump Company to notify Purchaser
of all holds and releases in service. Standby charges incurred during Pump Company clean up, or blowback. will be borne by the Purchaser. An additional charge. at Seller's
discretion, will be added for returned concrete due to clean up process.
8. POINT OF ACCEPTANCE. The Buyer's point of acceptance is at the truck chute. Seller will not accept responsibility for physical changes of the concrete caused by job
delays, delivery systems, placing equipment, or circumstances beyond our control.
9. READY MIX CONCRETE TESTING. Purchaser agrees that all ready mix concrete testing, including concrete strength testing for acceptance, shall be in accordance with ASTM.
UBC and ACI and that Seller will be provided with a copy of all test results within three (3) working days of the performance of said tests.
10, NOTIFICATION OF DEFICIENT CONCRETE COMPRESSIVE STRENGTH TEST RESULTS. Purchaser agrees to notify Seller in writing within twenty-four (24) hours of deficient
concrete compressive strength test results, to retain test specimens, and to make them available to Seller for further inspection and testing.
11. ADDITION OF WATER AND/OR FOREIGN MATERIAL. if water and/or foreign material is added to the concrete by or at the request of the Purchaser, its employees. agents,
contractors or subcontractors, Purchaser accepts the concrete as delivered and waives all right to reject, revoke acceptance or assert any claim for breach of any warranty and
Seller is not responsible for strength or properties of the concrete.
12. WARRANTY. Seller warrants that the compressive strength of ready mixed concrete test specimens tested for acceptance in accordance with ASTM will meet the design
strength for the mix design sold under this Contract. Seller warrants the aggrec ate material sold under this Contract meets the description and specifications for the same set
forth in this Contract. No other warranties, express or implied. are made with respect to such construction materials, whether they be warranties of fitness or warranti(s of
merchantability. Purchaser's exclusive remedy for breach of this warranty shall be to require Seller. at Seller's option, to refund the purchase price, to repair said material. or to
provide Purchaser with a conforming replacement for any non -conforming materials. No consequential damages may be claimed by Purchaser against Seller in connection with
any breach of this Agreement or breach of warranty herein. THE PRECEEDING WARRANTY IS IN LIEU OF AND SELLER HEREBY EXPRESSLY DISCLAIMS ALI. IMPLIED
WARRANTIES OF MERCHANTABILITY AND OF FITNESS FOR ANY PARTICULAR PURPOSE.
13. LIMITATION ON DAMAGES. Seller assumes no responsibility for, and shall not be liable to, Purchaser for any consequential damages incurred by Purchaser in connection with
this Contract, including without limitation, Purchaser's lost profits, Purchaser's good vvill, and any injury to person or property proximately resulting from any breach by Seller or
breach of warranty by Seller.
14. CLAIMS AND BACK CHARGES. Purchaser', exclusive procedure to, _)mmencinq claims under this Contract against Seller for any reason, including breach of contact or
breach of warranty. shall be as follows: Notice of claims against Seller to ,thy reason, including but not limited to, breach of contract or warranty, must be giver, to Seller in writing
within three (3) working days after discovery or when discovery should have been made. The written claim shall include the reason(s) and grounds for the claim and the dollar
amount or relief sought. FAILURE OF PURCHASER TO GIVE SUCH NOTICE WITHIN THREE (3) WORKING DAYS SHALL CONSTITUTE A WAIVER BY PURCHASER OF ITS
RIGHT TO LATER MAKE ANY SUCH CLAIM. If a dispute arises and cannot be resolved, the parties involved agree to binding arbitration through non -legal personnel.
15, TITLE AND RISK OF LOSS. Unless otherwise expressly stated herein. title to the materials sold hereunder shall remain with Seller until Seller has received full payment for the
same. Risk of loss of the materials sold under this Contract shall pass to the Purchaser upon delivery of the same, at the place of delivery designated herein. Thereafter, in
addition to assuming all risk of loss. Purchaser shall be responsible for compliance with all governmental regulations and ordinances with regard to storage or placement of the
same and shall indemnify and hold Seller harmless against all claims for personal injuries, including death. and property damage arising from the storage, use or handling of said
materials.
16. CONCRETE WARNINGS. Injurious to eyes. Causes skin Irritation. Avoid contact with eyes and skin. Wear waterproof gloves, a fully buttoned long-sleeved shirt, full-length
trousers, and tight fitting eye protection when working with these materials. If you have to stand in wet concrete, use waterproof boots that are tight at tops and 'nigh enough to
keep concrete from flowing into them. If you are finishing concrete, wear kneepads to protect knees. FIRST AID: If dust is inhaled. remove to fresh air. Get medical attention if
irritation persists. Wash wet concrete, mortar, cement, or cement admixtures from your skin with fresh, clean water immediately after contact. Indirect contact through clothing
can be as serious as direct contact, so promptly rinse wet concrete, mortar, cement or cement mixtures from clothing. Seek immediate medical attention if you have persistent
or severe discomfort. Avoid breathing dust from cutting or grinding hardened concrete. When exposed to concrete dust above recommended limits (see MSDS!, wear suitable
NIOSH/MSHA-approved respirator. In case of eye contact. flush with plenty of water for at least 15 minutes. Consult a physician immediately. KEEP OUT OF REACH OF
CHILDREN, USER AGREES TO CONVEY THIS WARNING TO ALL PERSONS WHO MAY USE OR COME INTO CONTACT WITH WET (UNHARDENED) CONCRETE, MORTAR.
CEMENT OR CEMENT MIXTURES.
WEEKLY INSPECTION DIARY
PROJECT NAME;S�SZ r-' . l c . "r) . ��Ge,,,ng1j7PERMIT NO:
DATE: From:
To:
L2 , " V C • 6�:
INSPECTOR SIGNATURE DATE
p city of
EXECUTIVE DEPARTMENT
M E M O R A N D U M
DATE: June 22, 2012
TO: Andrew Weygandt, PW - Utilities
FROM: Cindy Moya, Records Management Specialist
SUBJECC CAG-12-056— B & B Utilities and Excavating. LLC.
The attached document has been fully executed and is being returned to you. Please
transmit the original to the contractor and retain a copy for your file. The City Clerk has
retained an original for the file.
Thank you!
hArecords specialist\correspondence & memos - cindy\contract - fully executed.doc
wwwwwww ff M
WEEKLY INSPECTION DIARY
PROJECT NAME:52:6-4�, C_/.c,(.. ERMIT NO:
DATE: From: �cy�f To:
C'�
1 SPECTOR SIGNATURE DATE
PROJECT
DATE:
WEEKLY INSPECTION DIARY
PERMIT
Fro �O 5 To•
NO:
INSPECTOR SIGNATURE
DATE
WEEKLY INSPECTION DIARY
PROJECT NAME: V-PERMIT NO:
DATE: From: To•
INS C R SIGNATURE ATE
WEEKLY IN PECTION DIARY
PROJECT NAME: — �' PERMIT NO:
DATE: From: ' To:
INSPECT SIGNATURE DATE
WEEKLY INSPECTION DIARY
PROJECT NAME:.58c_ERMIT NO:
DATE: From:—?/4=-:21 To:
INSPECT R §IGNATURE
DATE
WEEKLY INSPECTION DIARY
PROJECT NAME• 6 RMIT NO:
DATE: From: To:
�.
fJ
INSPECTO OrglGNAT11RE
DATE
DATE:
WEEKLY INSPECTION DIARY
NAME: - / U PERMIT NO:
From: %/� ! /�- To'
%00,iop� lllll
_ME
C2-eg
s
ATURE
DATE
WEEKLY INSPECTION DIARY
PROJECT NAME &� 2t r,- �4PERMIT NO:
DATE: From: I To: IO lL 6 l,
WSJ
INSPECTOR SIGNATURE DATE
t s' _ i SEAT'L fl -803 c ++a o a N S., Seattle
CONCRETE t Hwy., Tukwila
RE.'v'TO'v P a-t -.: 91 o ra„e .a: N., Renton
= = TEN7-1 AVENUE SOUTH CEDAR SHOPES (Plant #20! 21010 Cedar Grove Rd. S.E., Maple Valley
-i LE; WA 98i08 • (206) 762-2566 A DIVISION OF GARY MERLINO CONSTRUCTION COMPANY. INC
DELIVERY. TICKET
• ACCOUNTING (206) 762-2566
FAX (206) 762• 235.
sA' CS
ORDER DESK (425) 226-1000
AM
LEAVE Pt;ANi (
ARRIVEJCIB
BEGIN POUR
FINISH PAUFL -
LEAVE JOB
ARRIVE PLANT
PM
J
DATE
CUSTOMER NO.
ORDER NO.
PROJECT
PLANT #
CUSTOMER NAME
I
CUSTOMER P.O.
JOB NO. DELIVERY TICKET NO.
JOB ADDRESS
COLLECT ON DELIVERY (C.O.D.)
1
CASH D CHECK # ❑CHARGE
MAP ZONE
7-
CARD # EXP. 7
SPECIAL INSTRUCTIONS
❑ VISA 0 MASTERCARD ❑ DISCOVER
QUANTITY
PRODUCT
CODE
DESCRI PliON
UNIT PPICE
TAX
AMOUNT
JOB TOTAL SLUMP
SPACING
ORDERED BY
�� •� DRIVER
REMIT PAYMENT TO SALES TAX
WATER ADDED ON -SITE
9125 10th AVE. S.
CYLINDERS
AUTHORIZED BY:
SEATTLE, WA BALANCE FORWARD
i
❑ YES
98108
TERMS 0 N REVERSE 0AMOUNT
gals. to full load
❑YES
REASON FOR DELAY TIME:
gals. to 2/3. load
❑ YES
— JOB NOT READY LACK OF HELP ❑ ADDING WATER E WHEEL BARROW JOB
ARRIVED JOB EARLY = TRAFFIC ❑ TRAIN n DRAW BRIDGE
gals. to 1 %3 load
NONE
= WAITING FOR TRUCK TO UNLOAD ^ PUMP BLOW -BACK
= WAITING ON PUMP C WASH PUMP C' OTHER
ADDITION OF WATER WILL REDUCE
- WARNING -
RELEASE — CUSTOMER RE' EASES AND AGREES TO HOLD HARMLESS ST'3t+1€WAY CONCRc 3 E,
STRENGTH. WATER ADDED AT
IRRITATiOs! TO
1 A I)P PS!ON OF GA.RY MERL)NO CONSTRUCTION COMPANY, INC. FOR A14`! DAMAGE TO HIS REAL
SKIN AND EYES OP . ERSONAi. PROPERTY CAUSED BY DELIVERY OF MATERIALS LISTED ABOVE. DETAILS OF SITE
CUSTOMER'S OWN RISK.
SEE REVERSE 06)
AGREFtVENT AC(;ESS ON BA i<,(5},
6 MINUTES PER CUBIC YARD
NOT RESPONSIBLE
FOR COLOR
CUSTOMER SIGNATURE
UNLOADING TIME INCLUDED.
VARIATION OR
SURFACE DATE
Additional unloading time charged at current hourly truck rate. PRINT NAME
— _ _ _ _ _ _ _ _ _ _ DISCOLORATION
— — — — — — — — — — — —
BATCH DATA:
— — — — —
rTICKET TOTAL
I!
REV 06/08 NBF 1 ass; .1a:- 1V,
Change Order
Northshore Paving, Inc. _ h
P.O. Box 1813 "Bothell, Washington 98041
425-488-7725 * 425-481-6598 * Fax 425-402-8732 BC
Lic #NORTHPI 131 N4
PROPOSAL SUBMITTED TO
B&B Utilities
DATE
REVISED 9/10/2012
ADDRESS Jeff
PHONE/ 206-406-0504
FAXf/
d06 NAME AND LOCATION cool
City of Renton Prevailing Wage
ARCHITECT
SE 5th St AC Water Main #WTR-27-3604
JOB PHONE
WE HEREBY SUBMIT SPECIFICATIONS AND ESTIMATES SUBJECT TO ALL TERMS AND CONDITIONS AS SET FORTH ON BOTH SIDES, AS FOLLOWS
SUBGRADE TO BE FIRM and UNYIELDING
ALL PREP BY OTHERS - PAVING ONLY
Job size reduced
Item 21 300 tons @ $102.30__ (30,690.00)
change to
Item 21 100 ton @ $131.92 13,192.00
(17,498.00)
New tonnage unit price $131.92
Original contract amount 30,690.00
change order (s) (17,498.00)
New Contract Amount 13,192.00
Due to the volatility of the oil (asphalt) market. this proposal is based on the cost of liquid asphalt (PG64-22) of the month prior to the bid date as shown on
WSDOT website http:l/www.wsdot.wa.gov/bizlconstruction/pdf/referencecosts pdf. Any increase in the cost of liquid asphalt between the bid date and the
time of placement will be itemized on your invoice based on the posted price for the month of installation and calculated at 5.6% of the total tonnage placed.
EXCLUSIONS: Engineering, Layout, Testing, Traffic Control, Utility Adjusments, Curbing, Prime Coat
Striping, Sawcutting, Sweeping, Permits, Misc. Patches, Bond.
TERMS: Net Cash upon completion of job. Jobs in excess of 30 days duration - Terms: Net Cash upon receipt of Progress Billing.
CONDITIONS:
1. This agreement is subject to Northshore Paving, Inc.'s approval of purchaser's credit within ten days of date of acceptance
Z Northshore Paving, Inc. shall not be liable for damage to or breakage of septic tanks, underground pipes and/or conduits not visible from the surface of the ground
nor for any damage to approaches (including sidewalks) from the street to property line.
3 It is agreed if case suit is instituted to collect amount due on this contract or any portion thereof, reasonable attorney's fees and court costs will be added to this contract.
4 Soil sterilization (weed killer). if included in contract, will be applied at rates specified by manufacturer Northshore Paving, Inc. will not be responsible for any
subsequent growths of horsetail weed, morning glory, deep -roofed fems or perennials which have not reached maturity prior to application.
5 A FINANCE CHARGE of 1.5% per month will be charged on past due accounts.
6 Quotations subject to change or cancellation after 30 days. I e e
7 All agreements are contingent on strikes, accidents, delays of carriers and other delays unavoidable or beyond our control.
8 Northshore Paving, Inc. shall not be responsible for subgrade failures
9 Any and all state, county or municipal permits required for the above -mentioned improvements will be obtained by purchaser unless otherwise stipulated.
10. Customer will be liable for any collection costs.
11 Northshore Paving Inc. assumes all jobs to be NON -Public Works and completed during normal workday hours, unless otherwise notified.
12. Northshore Paving Inc. does not guarantee drainage on grades less than 1 % _ NORTHSHORE PAVING, INC.
13. Prices based on current material wholesale costs. Contracts extending into a new calendar year are subject to revision of price when an increase occurs.
14. This Proposal MUST be included with the contract documents.
Estimator Signature Greg Ford
Accepted: The above prices. specifications and conditions are satisfactory and are hereby
accepted You are authorized to do the work as specified. Payment will be made as outlined above Signature x
Date Print Name & Title
Concrete: Injurious to eyes.Causes skin irritation.Contains Portland Cement. Read the following warning before using: Contact with wet,
unhardened concrete, mortar, cement or cement mixtures can cause skin irritation. severe chemical bums or serious eye damage. Avoid contact with
eyes and skin. Wear waterproof gloves, a fully -buttoned, long -sleeve shirk full-length trousers and tight -fitting eye protection when working with these
materials. If you have to stand in wet concrete, use waterproof boots that are tight at the top and high enough to keep concrete from flowing into them.
If finishing concrete, wear knee pads to protect knees. After contactwith any of these materials, wash off immediately with fresh, dean water. Indirect contact
through clothing is as dangerous so promptly rinse these materials from clothing. Seek immediate medical attention if you have persistent or severe
discomfort.ln case of eye contact, flush with plenty of water for at least 15 minutes. Consult physician immediately. KEEP out of reach of children! User
agrees to convey this warning to all persons who may use or cone into contact with wet (unhardened) concrete, mortar, cement or cement mixtures.
Aggregates: Prolonged inhalations of dust from a gravel product may be hazardous to your health Measures to control fugitive dust should be taken
when handling this product. Hot Asphalt emits nuisance fumes. Avoid breathing fumes. Also, Asphalt may cause severe bums. Wear protective
safety gear (tang sleeves, pants and gloves). If burned, cod with water and see a physician.
Water added at customer's own risk. Additional water added to concrete will Property Damage Indemnification & Release
reduce its strength. Buyer's agent agrees to accept responsibility for reduced strength The operator of this piece of heavy equipment. in presenting this RE -
due towater added abovedesign. LEASE to you for your signature. is of the opinion that the operation of this
orb with inch slump. machinery in the manner required to perform our contract with you may
Arrived at
I p � possibly cause damage to the premises or property. It is our wish to help
you in everyway that we can. but in order to do this, the operator is asking
Added gal water at customer request. Test cylinders that you sign this RELEASE. In consideration of the performance of the
taken seller of its contract with me, I the undersigned. hereby INDEMNIFY the
Other additions seller and its employees for any damage and for all damns to the premises.
building, utility pipelines or cables, telephone lines, driveway or other
by
ReceivedX t: appurtenances. a
Buyer's Agent receipt of product and approval of any added items. and RELEASE the seller and its employees from
The addition of any extra products to our mixer may void any warranty any liability.
expressed or implied by the seller. The seller accepts no liability for any
personal injury incurred by you while adding additional products to our
mixer. Signature of Owner or its Agent
Signature of Owner or its Agent .�WGDELTKT090408
Leave Plant Arrive, Job Site Start DischargJob Site � Finish Discharge Leave JArrive Plant
Drivers'
Comments
Order No. Cust. No.
Customer
Delivery Instructions
Load Qty Delivered Qty
Company/ Customer PO/
Customer Job Phase Code
Delivery Address
TICKETNO
Order Qty Product Code UOM Product Description
CUSTOMER/OFFICE
37a39?4
Unloading & Standby Excess unloading will be
charged at posted truck time rates. Truck standby
time charged at posted truck time rates.
Limited Warranty The only liability of the seller for
product defect is the return of the purchase price. In no
event shall the seller be liable for any direct, indirect,
incidental or consequential damages resulting from
the use of the products or arising out of breach of any
warranty. All claims for damages or shortages must be
made within 24 hours of dellvery.We do not assume
responsibility for any damage beyond the curb line.
Driver Co. Proj. No.
Date
Map Zone
Scale
Time:
Unit Price Amount
Load Size Prod. No. Description Slump Type CC Use Haul Cd. Pit/Plant Sales Tax
TOTAL DUE
Truck Gross Weight Tare Weight Trailer Trailer Taken by
Check #
CUSTOMER
Concrete: Injuriau to eyes.Causes skin initation.Contains Portland Cement. Read the fdlowing warning before using: Contact with wet,
unhardened concrete, mortar, cernent or cement mixtures can cause skin irritation, severe derrical bums or serious eye damage. Avid contact YA
eyes and skin. Wear waterproof gloves, a fully -buttoned, long -sleeve stet, full-length trousers and tight-fibng eye protection when wnrkirg with these
mauls, If you have to stand in wet ccricrete, use waterproof boils Chat are tight at the top and high enough to keep concrete from flowing into Chem.
If fnishR coriaete, wear knee pads to protect knees. After contact with any of these materials, wash cif immeclataly with fresh, dean water. Indirect contact
through dA% is as dangerous so praq* rinse these materials from dofhig. Seek immediate medical attention if you have persistent or severe
discomforth case of eye contact, flush with plenty of water for at least 15 minutes. Consult physician immedately. KEEP out of reach of diidren! User
agrees to convey this waning to all persons who may use or came into contact with wet (unhaidened) concrete, mortar, cement or cement mixtures.
Aggregates: Prolonged inhalations of dust from a gravel product may be hazardous to you heath. Measures to coribol fugitive dust should be taken
when handling Chis product Hot Asphalt emits nuisance fames. Avoid break ng fumes. Also, Asphalt may cause severe burrs. Wear protective
safety gear (long sleeves, pants and gloves). If barred, 000l with water and see a physician.
Water added at customer's own risk Additional water added to concrete will Property Damage Indemnification & Release
reduce its strength.Buyers agent agrees to accept responsibility for reduced strength The operator of this piece of heavy equipment, in presenting this; RE -
due to water added above design. LEASE to you for your signature, is of the opinion that the opwatiah of this
Arrived at job with in slum . machinery n the manner �� to P�� our contract with YW may
1 P F possibly cam damage to the premises or property. It is our wish to help
you in everyway that we can, but in order to do this, the operator is asking
Added gal water at customer request. Test cylinders that you sign this RELEASE. In consideration of the performance d the
taken seller d its contract with me, I the undersigned, hereby INDEMNIFY the
Other additions seer and its employees for any damage and for all clans to the per.
byceivedX �g, utility pipelines a cables, telephone fines, driveway a other
appurtenances, at
Buyer's Agent receipt of product and approval of any added items
The addition of any extra products to our mixer may void any warranty
expressed or implied by the seller. The seller accepts no liability for any
personal injury incurred by you while adding additional products to our
mixer.
and RELEASE the seller and its employees from
any liability.
Signature of Owner or its Agent
Signature of Owner or Its Agent $
Leave Plant 1 Arrive Job Situ Start Discharges Finish Discharge i Leave Job Site Arrive Plant
Drivers' -- - -- ----- —----�
Comments
Company/ Customer PO/
Order No. Cust. No. Customer Job Phase Code TICKET NO.
Customer Delivery Address
Delivery Instructions
Load Qty Delivered Qty OrderQty ProductCode UOM Pro
Unloading & Standby Excess unloading will be
charged at posted truck time rates. Truck standby
time charged at posted truck time rates.
Limited Warranty The only liability of the seller for
product defect is the return of the purchase price. In no
event shall the seller be liable for any direct, indirect,
incidental or consequential damages resulting from
the use of the products or arising out of breach of any
warranty. All claims for damages or shortages must be
made wnthin 24 hours of deiivery.We do not assume
responsibility for any damage beyond the curb line.
r ill, fill
Driver Co. Proj. No.
Map Zane
Sale
Time:
Unit Price Amount
Load Size Prod. No. Description Slump Type CC Use Haul Cd. PittPlant Sales Tax
TOTAL DUE
Truck Gross Weight Tare Weight Trailer Trailer
Check #
��r•�r•s���111111111 �M�0111111 aiiiiiiii Maiiiiiiin
91155777 //C E M E x
1901131654
Date
Plant # Plant Name
Ticket Time
24,'4 �';
ii�tl1 - Y erilf-ior2A-phait
Zone Map ID
Project #
Job #
PO #
- SROAL
Customer # Sold to
Truck #
NORTH SHORE PANA 3 iP1i::
2534382
Delivery Address
HaulefRruok Dewriptlon
3016 SE 5TH ST
PA`*r3
WeighMaster
RENTC+1 EiOTF+ELi.. t1+A, 98028
Instructions
Lb Mebric Ton
Gros
0 0 0f7 u 00
Fare:
Wilea 30.38 3349
Net,
j1 0.00 000
t Pro
ietermined Tare
LOAD CUMULATIVE # OF PRODUCT
PRODUCT UNI
AMOUNT
QUANTITY QUANTITY LOADS CODE DESCRIPTION PRICEANIkk
SUBTOTAL
TAX
The undersigned promises to pay all costs, including reasonable
- 'I TO SE MAi _ ,gd LINE
Dear customer: The driver of this truck who is presenting this RELEASE to you for your signature is of the opinion that the size and weight of his truck
attorney's fees, incurred in collecting any sums owed.
may possibly cause damage to the premises anu/or adjacent property n heplaces me material in the load where you desire A. It is our wish, to help
you in every way that we can, but in order to do this the driver is requesting that you sign this RELEASE relieving him and this supplier from any
All accounts not paid within 30 days of delivery will bear interest
responsibility Item any damage that may occur to the premises and/or adjacent property, buildings, sidewalks, drive -ways, curbs, etc, by the delivery
of this material and that you also agree to help him remove mud from the wheels of his vehicle so that he will not litter the public street Further, as
at the rate of 180o per annum.
additional consideration. the undersigned agrees to indemnify and hold harmless the driver of this truck and this supplier for any and all damage to
the premises and/or adjacent property which may be claimed by anyone to have arisen out of delivery of this order.
Not Responsible for Reactive Aggregate or Color Quality. No
SIGNED
Claim Allowed Unless Made at Time Material is Delivered.
A S40.00 Service Charge and Loss of the Cash Discount will be
' ' ' ' ' '
collected on all Returned Checks.
ale
LOAD RECEIVED BY: X
Standby
AUTHORIZED SIGNATURE
Time Initials
The signature above signifies receipt and acceptance of the listed materials and acknowledgement
of and agreement to the terms and conditions on the face and reverse side of this ticket.
91..55744
19101131602
Date
Plant # Plant Name
Ticket Time
Q91` 4/'110112
1Q0J-kenMor#A phak
Project #
Job # PO #
Zone Map ID
VE
Customer #
Sold to
Truck #
NOR TH 'HORE PAVWIG INC
Delivery Address
Hauler/Truck Description
ST
PYRTHISH., *E PAIANG
WeiglWaster
RENTON
Instructions
OF
80THEU. r WA., 98028
SUB -TOTAL
The undersigned promises to pay ail costs, including reasonable
attorney's fees, incurred in collecting any sums owed.
All accounts not paid within 30 days of delivery will bear interest
at the rate of 1 Sc% per annum.
Not Responsible for Reactive Aggregate or Color Quality. No
Claim Allowed Unless Made at Time Material is Delivered.
A $40.00 Service Charge and Loss of the Cash Discount will be
collected on all Returned Checks.
Standby
Time Initials
TAX
CO-051. U 000 000
Tcke- 30.38 33.49
Neit. t -00 000
k Pt Pc eterftltned 1 are
TICKET
r L,AMAGE AELEA :; t ON--�
Dear Customer: The driver of this truck who is presenting this RELEASE to you for your signature is of the opinion that the size and weight of his truck
may possibly cause damage to the premises and/or adjacent property if he places the material in this load where you desire it. It is our wish to help
you in every way that we can, but in order to do this the driver is requesting that you sign this RELEASE relieving him and this supplier from any
responsibility from any damage that may occur to the premises and/or adjacent property, buildings, sidewalks, drive -ways, curbs, etc. by the delivery
of this material and that you also agree to help him remove mud from the wheels of his vehicle so that he will not litter the public street. Further, as
additional consideration, the undersigned agrees to indemnify and hold harmless the driver of this truck and this supplier for any and all damage to
the premises and/or adjacent property which may be claimed try anyone to have arisen out of delivery of this order.
SIGNED
LOAD RECEIVED BY: (JX
''AUTHORIZED SIGNATURE
The signature above signifies receipt and acceptance of the listed materials and acknowledgement
of and agreement to the terms and conditions on the face and reverse side of this ticket.
91155745
Date Plant # Plant Name
i9ui 11enn'ir'reA-5phaR
Project # Job #
Customer # Sold to
h1CATHSHORE PAV1 3 INC
Delivery Address
i 16 SE 5TH ST
I Instructions
CUMU-ATIVE
qq
4 n+i Tr) ! 1 4708
SUB -TOTAL
//CC-mcx
PO #
i/G(SAL
1901131603
Ticket Time
Zone Map ID
Truck #
Hauler/Truck Description
17HCIRE PA..M3
WeighMaster
BOTHELl.'.'tA, ArrJO"'tt
1. T.1 IVSNSJ7C
(tire U U U0
F arty g.72
Net G Il OG
11 Pre° etermirted Tare
PRODUCT
trial CODE
HMA"
The undersigned promises to pay all costs, including reasonable
attorney's fees, incurred in collecting any sums owed.
All accounts not paid within 30 days of delivery will bear interest
at the rate of 18% per annum.
Not Responsible for Reactive Aggregate or Color Quality. No
Claim Allowed Unless Made at Time Material is Delivered.
A S40.00 Service Charge and Loss of the Cash Discount will be
collected on all Returned Checks.
Standby
Time Initials
TAX
tan
101.011
5.31
000
.. ;.I , DAI,'A'�c. .1 1 i- 1 �!,,t._NY IS TO C::
Dear Customer: The driver of this truck who is presenting Bits RELEASE to you for your signature is of the opinion that the size and weight of his truck
may possibly cause damage to the premises an ilor adiecent property if he places the material in this load where you desire it. It is our wish to help
you in every way that we can, but in order to do this the driver is requesting that you sign this RELEASE relieving him and this supplier from any
responsibility from any damage that may occur to the premises and/or adjacent property, buildings, sidewalks, drive -ways, curbs, etc. by the delivery
of this material and that you also agree to help him remove mud from the wheels of his vehicle so that he will not litter the public street. Further. as
additional consideration, the undersigned agrees to indemnity and hold harmless the driver of this truck and this supplier for any and all damage to
the premises and/or adjacent property which may be claimed by anyone to have arisen out of delivery of this order.
SIGNED
LOAD RECEIVED BY: k ..'
AUTHORIZED SIGNATURE
The signature above signifies receipt and acceptance of the listed materials and acknowledgement
of and agreement to the terms and conditions on the face and reverse side of this ticket.
rswTnurr�rr��c n�nv
Date
Project #
955750
Plant # Plant Name
Job #
/ZCC-MEX
PO #
1901131611
Ticket Time
Zone Map ID
Customer # Sold to Truck #
NORTH5HC )RE Fe`AAJ':i IN(;
Delivery Address Hauler/Truck Description
<t118 SF 571-1 ST 9 4 !1? rH H,,JPE PAVAIG
WeighMaster
;4ENTON Hl_,1HELL, vik m2k-
Instructions Lr metnc Ion
Giro 0 U t3U 6 00
i ace 42,120 19.11 21 06
0.00 000
F're etermined 1 are
CUMULATIVE # OF PRODUCT
QUANTITY LOADS CODE
44
SUB -TOTAL
The undersigned promises to pay all costs, including reasonable
attorney's fees, incurred in collecting any sums owed.
All accounts not paid within 30 days of delivery will bear interest
at the rate of 18 % per annum.
Not Responsible for Reactive Aggregate or Color Quality. No
Claim Allowed Unless Made at Time Material is Delivered.
A S40.00 Service Charge and Loss of the Cash Discount will be
collected on all Returned Checks.
Standby
Time Initials
AMOUNT
TAX
M
.::. r DAMAGE RELEA:.t .'i: RYIS TC 'N l )E t:'
Dear Customer. The driver of this truck who is presenting this RELEASE to you for your signature is of the opinion that the size and weight of him truck
may possibly cause damage to the premises and/or adjacent property if he places the material in this load where you desire it. It is our wish to help
you in every way that we can, but in order to do this the driver is requesting that you sign this RELEASE relieving him and this supplier from any
responsibility from any damage that may occur to the premises and/or adjacent property, buildings, sidewalks, drive -ways, curbs, etc. by the delivery
of this material and that you also agree to help him remove mud from the wheels of his vehicle so that he will not litter the public street. Further, as
additional consideration, the undersigned agrees to indemnity and hold harmless the driver of this truck and this supplier for any and all damage to
the premises and/or adjacent property which may be claimed by anyone to have arisen out of delivery of this order.
SIGNED
NOTICE: MY SIGNATURE BELOW INDICATES THAT I HAVE READ THE HEALTH WARNING NOTICE AND SUPPLIER
WILL NOT BE RESPONSIBLE FOR Alk Y DAMAGE CAUSED WHEN DELIVERING INSIDE CURB LINE.
LOAD RECEIVED BY: kk AUTHORIZED SIGNATURE
aboveThe signature _ipt and acceptance of the listed materials and acknowledgement
of and agreement to the terms and conditions on the face and reveirse side of r
9115 557 5 9 zzCC_MEx
190113162Z
Date
Plant # Plant Name
Ticket Time
u 1 - 'Kenrzc-I Asphalt
Zone Map ID
Project #
Job #
PO #
VERBAL
Customer # Sold to
Truck #
MORTHSHORE PAtilNG INC
Delivery Address
Hauler/Truck Description
3016 SE 5TH 5T
,n rx{�`.. ;UE PAtAW
WeighMaster
9,711 `CLL, WA, QM16
Instructions
Mett'c oft
tJ 0.60 0 GU
1 are
be,980 31338 33.49
Wet-
n, (100 Goo
' Pi
etwined Tart -
LOAD CUMULATIVE # OF PRODUCT PRODUCT UNIT AMOUNT
QUANTITY QUANTITY LOADS CODE DESCRIPTION PRICE
TICKET
SUB -TOTAL
TAX
_ TOSffiNTAL
The undersigned promises to a all costs, including reasonable
9 P pay g
esr r l RE E TOto
who
Deer Customer: The driver of this truck who L4 presentlng this RELEASE to you for your signature is of the opinion that the size and weight of his truck
attorney's fees, incurred in collecting any sums owed.
may possibly cause damage to the premises and/or adjacent property it he places the material in this wad where you desire a. It is our wish to help
you in every way that we can, but in order to do this the driver is requesting that you sign this RELEASE relieving him and this supplier from any
All accounts not paid within 30 days of delivery will bear interest
responsibility from any damage that may occur to the premises and/or adjacent property, buildings, sidewalks, dove -ways, curbs, etc. by the delivery
of this material and that you also agree to help him remove mud from the wheels of his vehicle so that he will not litter the public street. Further, as
at the rate of t 8% per antrum.
additional consideration, the undersigned agrees to indemnify and hold harmless the driver of this truck and this supplier for any and all damage to
the premises and/or adjacent property which may be claimed by anyone to have arisen out of delivery of this order.
Not Responsible for Reactive Aggregate or Color Quality. No
SIGNED
Claim Allowed Unless Made at Time Material is Delivered.
A S40.00 Service Charge and Loss of the Cash Discount will be
• • ' " • '
collected on all Returned Checks.
,11 • • •
LOAD RECEIVED BY �XJ
Standby
AUTHORIZED SIGNATURE
Time Initials
The signature above signifies receipt and acceptance of the listed materials and acknowledgement
of and agreement to the terms and conditions on the face and reverse side of this ticket.
91'55168
//CC-MEX
1901131W
Date
Plant # Plant Name
Ticket Time
ird I :(.:UI
i91�i - i�ennlor(- Asphalt
JIj,
;:•r;.
Zone Map ID
Project #
Job # PO #
4'ERS�L
Customer f
Sold to
Truck #
NORTH%*iRE FA+A1', G jh C
Delivery Address
Hauler[Truck Description
?Q1B GE 5TH ST
`l7iP .!�}40RE PAMNG
WeighMaster
r ENTuhl
BC, MELL, V`-j 98f128
Instructions
meftic
Ion
Gros
G Goo
0 00
tare.
66,980 30 38
3349
Net
0 0,00
000
' Pireitleterminpd
1 are
LOAD CUMULATIVE # OF
QUANTITY QUANTITY LOXQI
C
SUB -TOTAL
The undersigned promises to pay all costs, including reasonable
attorney's fees, incurred in collecting any sums owed.
All accounts not paid within 30 days of delivery will bear interest
at the rate of 18 % per annum.
Not Responsible for Reactive Aggregate or Color Quality. No
Claim Allowed Unless Made at Time Material is Delivered.
A $40.00 Service Charge and Loss of the Cash Discount will be
collected on all Returned Checks.
Standby
Time Initials
►n
"I 4,Pf H. Y DAh',, . ' St, JNF':' i O lii. VAi'.
Dear Customer: The driver of this truck who is presenting this RELEASE to you for your signature Is of the opinion that the size and weight of his truck
may possibly cause damage to the premises and/or adjacent property if he places the material in this load where you desire it. It is our wish to help
you in every way that we canbut in order to do this the driver is requesting that you sign this RELEASE relieving him and this supplier from any
responsibility from any damage that may occur to the premises and/or adjacent property, buildings, sidewalks. drive -ways, curbs, etc. by the delivery
of this material and that you also agree to help him remove mud from the wheels of his vehicle so that he will not litter the public street. Further, as
additional consideration, the undersigned agrees to indemnify and hold harmless the driver of this truck and this supplier for any and all damage to
the premises and/or adjacent property which may be claimed by anyone to have arisen out of delivery of this order.
SIGNED
WILL NOT • FOR ANY DAMAGE
LOAD RECEIVED BY:
AUTHORIZED SIGNATURE
The signature above signifies receipt and acceptance of the listed materials and acknowledgement
of and agreement to the terms and conditions on the face and reverse side of this ticket.