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SUPER
IR `The On Time Concrete Company"CENTRAL CONCRETE SUPERMIX, INC.
CONCRETEDISPATCHERS:3 )HRf l 11 1 � II 11/1111111 Ise!IN
DEERFIELD: (954)480-9333 CUSTOMER NO. DELIVERY TICKET Y DATE
BLOCK PLANT:(305)805-3226
WWW.SUPERMIX.COM
MAIN OFFICE: 4300 S.W. 74th Ave. • Miami, FL 33155
PHONE: (305) 262-3250 • FAX: (305) 267-0698
SERVING MIAMI-DADE, BROWARD,PALM BEACH, MARTIN & ST. LUCIE COUNTIES
SOLD TO DELIVERY ADDRESS
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QUANTITY DESCRIPTION PRICE UNIT EXTENSION
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MINUTES — ALLOWABLE TIME' — PER MINUTE
EXTRA UNLOADING TIME CHARGE X$1.00
*6 MINUTES PER CU. YD. ALLOWED SHORT LOAD CHARGE
SLUMP AMOUNT
THIS,DELIVERY TOTAL CU. YDS.
I . 9 i_l
OF YOUR ORDER FOR CU. YDS. TAX
. ;
CUSTOMER OR HIS AGENT ASSUMES FULL RESPONSIBILITY FOR STRENGTH AND/OR
PERFORMANCE OF ANY CONCRETkPLACED ABOVE DESIGN SLUMP OR WHEN •
WATER IS ADDED. WATER ADDED -IDYES ❑ NO C GLS.
TIME ARRIVED ON JOB STARTED UNLOADING FINISHED UNLOADING LEAVING THIS JOB TOTAL TIME
SUBJECT TO THE TERMS, CONDITIONS AND "CAUTION" WARNING LISTED ON BOTH THE
FRONT AND BACK OF THIS TICKET.
TRUCK DRIVER I acknowledge that I have received and accepte _the materials listed,on this ticket. I
understand and agree to the terms on both,thI6 front and ba k'of t,Ks Vaget.
RECEIVED BY: XJ
CONTROL 20 LOADING POINTS AT 16 LOCATIONS TO SERVE YOU BETTER
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o0.�OG(ON,qi MIAMI•DOWNTOWN MIAMI•WEST MIAMI•AIRPORT OPA-LOCKA•MEDLEY•PERRINE•PEMBROKE PINES
Ll4- i1 13 Gc 3 Zl 4 DEERFIELD•BOCA RATON•RIVIERA BEACH•STUART•W.BROWARD•FT.PIERCE•E.BROWARD•DELRAY
PRODUCERS AND SUPPLIERS OF QUALITY READY MIXED CONCRETE AND CONCRETE BLOCK NRMCA
asso�+ DELIVERY COPYEa
.,.�Yi� S,uM1 r-� `"' �- r - ., •may' .�
Tom. V6 A Y
588 NW Mercantile Place Port St.Lucie, FL 34986
Office 772-879-0904 Fax 772-879-1116 Email:Service@CoastalPestControiFL.com
Certificate of Termite Treatment® Soal Treatment
Permit#S L C,�, .t"e�-c.20�ob Street Address ;:5Z' O )iA
Jobtity,State,Zip "®ter 44 uc:
Builded"L Legal Description:Section� BlockS7�? Lot a O
Soil Treatment Company Information
Coastal Pest Control of the Treasure Coast Inc.
588 NW Mercantile Place Port St.Lucie,FL 34986
D.A.C.S. License#JB55944/Certificate#8068
Treatment Information Second Treatment/Final
1.5 Treatment Date/Time / Treatment Date/Time
_T4'L SrAl Chemical Used Chemical Used
'01P yo Concentration Concentration
Gallons Used Gallons Used
Wb Q,65T Application Method Application Method
/ 0,6 Linear/Sq re ootage / Linear/Square Footage
APPLICATAIR SIGIMATU E
FBC104.2.6 certificate of Protective Treatment for Prevention of Termites
A weather resistance jobsite posting board shall be provided to receive duplicate treatment certificates as each required protective
treatment is completed,providing a copy for each person the permit is Issued to and another copy for the building permit files.The
treatment certificate shall provide product used identity.of the applicator,time and date of the treatment,site location,area treated,
chemicals used,percent concentration,and number of gallons used,to establish a verifiable record of protective treatment.If the soil
chemical barrier method for termite prevention Is used,final exterior treatments shall be completed prior to final building approval.