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MOBILECRETE
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TECHNOLOGIES 0 Metered and Mixed Fresh On -Site VISA
772.466.5070 ❑ AMEX
3825 Selvitz Road, Ft. Pierce, Florida 34981
I
Date: >� I Cubic yds. ordered:
1
Time of job:
Customer Name: �`� �`�� Phone:
Delivery Address: i c)--) J tJ J for
City: gg t 1I
Project Name: iJ W P.O.*
YARDS
USED
MIX DESIGN,
REG.`IPUMP)
PEA ROCK
PRICE
PER YD
AMOUNT
s#57/67
F� / AD MIX
OTHER
TIME
ON JOB
TIME
STARTED
TIME
FINISHED
DELIVERY
CHARGE
TRUCK
O.T. FEE
10 Minutes of FREE
unloading for every yard.
$1.00 per Minute After
SHORT LOAD
FUELSURCHARGE
ENVIRONMENTAL
SUB TOTAL
;3<
TAX
®�
TOTAL
t,
REMARKS: tt �-- J Y l 4C i 01 i' r,43' 6 ` jr cr
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Purchaser assumes full responsibility for strength, slump and quality of concrete when -
changing the calibration of sand, rock or water, or other material requested on the job.
I, the undersigned, will assume alesponsibility for any -damage where delivery is made
inside of the curb.f�
/J
Customer X: f / /���' Driver: J tJ
Meter Reading: Truck Number: M)