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1142 Waterjower Road, Lake Park FL 33403 J 1713 '
Office. 1+8.77-484-9994 / Fax:561-844-7102
South East Florida Division Dispatch:561-844-9994 / Central Florida Division Dispatch:407-339-5311
Concrete Tested ❑Yes ❑No LOT# Water Added at Customer's
Cylinders Taken, ❑Yes F-1 No Request , '
gals.to full load
Comments
gals.to 2/3 load.
gals.to 1/3 load
Customer's Rep-Water Added
NOT-RESPONSIBLE FOR 'WARNING IRRITATION TO THE SKIN-AND EYES ,ADDITIONALVATER ADDED TO THIS
VARIATION`iN COLOR OR Cement polymer or freshly mixed concrete may-cause skin injury.Avoid contact with_
SURFACE DISCOLORATION skin and wash exposed skin areas promptly with.water. If any�cement.powder or CONCRETE WILL REDUCE ITS STRENGTH
mixture gets into eyes, rinse immediately and repeatedly with water and get prompt dND DURABILITY:ANY WATER ADDED IS
BATCH TIME medical attention. Keep children away from cement powder and all freshly mixed „ AT CUSTOMER'S OWN RISK.
cement products,
PLANT TICKET,#, ORDER';# ��,,RyCkft
LOAD SIZE . MIX r — SLUMP , DATE;. a.. . _4 is ..l• -
CUSTOMER# SOLD Tg' + ,. _ p 0 C fi
#y. PROJE T'#
DELIVERY ADDRESS ZONE# ,•y 5 USB DRIVER t
INSTRUQTIONj,_ TIME DUE.
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SIGNATURE OR RECEIPT-CONCRETE AND ACKNOWLEDGEMENTOF HAZARD WARNING
asc meyer Concretq, ompany will not assume Ia i rty for anyr property amage or any SUB-TOTAL
equipment damage for any deliveries beyond the curb line.
' TAX
AUTHORIZED BY
SHIPMENT SUBJECT TO CONDITIONS ON REVERSE SIDE. sf, TOTAL
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1
F. COUNTY
2300 Virginia Ave
Fort Pierce, FL 34982
772-462-2172 Fax 772-462-6443
CERTIFICATE OF TERMITE TREATMENT
CONSTRUCTION SOIL TREATMENT
PERMIT #: rs i 1 ..00( JOB ADDRESS: U32-Z-
BUILDER/CONTRACTOR: -'.P-ni - -�-evDL-�
PEST CONTROL CONTRACTOR: 1 e
PEST CONTROL LICENSE #: \ 2\ '-
Z-We, the undersigned, hereby certify that we have pretreated the above described construction for
subterranean termites in accordance with the standards of the National Pest Control Association.
Square feet if area treated: Chemicals used: t - (I
Percentage of solution: ?® Total gallons used:
Date of Treatment: Time of Treatment:.
Footing Slab
1st Treatment 1st Treatment
' Re Treat Re-Treat
,.- -;-:::Re-Treat
Pools
15C Treatment 1st Treatment
Re-Treat Re-Treat
Other Perim r Final Inspection
1st Treatment
Re-Treat
ignatu.re of Exterminator
Note. There must be a completed form for each required treatment or re-treatment and this form must be on the job
site to be picked up by the inspector at time of each inspection or the scheduled inspection will fail and a re-inspection
fee charged.
FBC104.2.6 Certificate of Protective Treatment for prevention of termites A weather resistant jobsite posfing board
shall be provided to receive duplicate Treatment Certificates as each required protective treatment is completed,
providing a copy for the person the permit is issued to and another copy for the building permit files The Treatment
Certificate shall provide the product used, identity of the applicator, time and date of the treatment,site location,area
treated, chemical used,percent concentration and number of gallons used, to establish a verifiable record of
protective treatment. 9 the soil chemical barrier method for termite prevention is used, final exterior treatment shall
be completed prior to final building approval.
St Lucie County requires for the final inspection for CO, a Permanent Sticker to be placed on
the electrical panel box cover, listing all the treatments and dates of aRR1111cations.