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TECHNOLOGIES Ll MC
Metered and Mixed Fresh On-Site 0 VISA
772.466.5070 Q AMEX
3825 Selvitz Road, Ft. Pierce, Florida 34981
Date: Cubic yds.ordered: f 'J
Time of job:
Customer Name: Phone:
Deiive,v Address:
City:
Project Name: P.O.#:
YARDS MIX DESIGN, PEA ROCK PRICE
USED REG,:/PUMP,, #57/67 PER YD AMOUNT
FIBER/AD MIX JOTHFR
M
"N JT'I TIME TIME DELIVERY
O _E I -
OB STARTED FINISHED CHARGE
TRUCK
O.T.FEE
SHORTWAD
10 Minutes of FREE FLIELSURCHARGE
A—
unloading for every yard.
ENVIRONMENTAL
$1.00 per Minute After
SUBTOTAL
TAX
TOTAL DUE .4
REMARKS:
Puedhaser assumes full responsibility for strength, slump and quality of concrete when
changing the,621!bration of sand, rock or water, or other material requested on the job.
'—I—the will assume all responsibility for any damage where delivery is made
inside of the cur]J4' - ! 1- I
Customer X A Driver:
Meter Reading: Truck Number: