Correspondence i u 13125 SW Hall Blvd. � Y r � V Co CJ� -t
. ._, 0 Ti gard, OR 97223
T I(;ARD 503.639.4171
I
Inspection Requests: 503.639.4175
Permit No 'LM2010 -00204 '
Site Address 10195 SW KAI3LE 51
Connect existing house to sewer service.
Description •
Reimbursement District / /45 fee paid.
ontractor
hone No I
nspection Request Scheduled For:
Date • une 30, 2010
Pour Time /A •
Inspection Code 05 Sanitary sewer
Request Comment 133454)1 MSG! 503- 519 -8409 " ` '
Requesters Phone 03- 519 -8409
Result Comments
OK I OMAKL- CONNL I'0 IIOUSL.
SUBMI F PUMP AND FILL Ri.CLIP f I ICKL I S I 0 COT BUILDING
DEP I . ONCL ULCOMMISSION IS COMPLLTLU.
t esults ASS
n spector ick Bolen
Date ' une 30, 2010
hone No 503718 -2424
•
•
•
SALES /DELIVERY TICKET LOAD •
•
•
173935 TIME �/" :, 1.•.
• �� Portland Administrative Offices LEAVE / '
1050 N. River Street Portland Dispatch PLANT /(" j
P ortland, Oregon 97227 Front Avenue (503) 243 -5535 ARRIVE e
• G L' C 1 E R (503) 335-2600 • Vancouver (360) 892-0210 JOB ,y,, :� r,;(
N O R T H W E S T -
START
WARNING: IRRITATION TO SKIN & EYES REASONS FOR DELAY TIME POUR
This product contains Portland Cement. Freshly mixed cement, mortar, grout, or concrete may cause skinr7itation -
and /or allergic•reaction. Do not use without protective gear and clothing. Avoid any direct contact with skin. Wash ❑ JOB NOT READY FINISH
exposed areas immediately with water. If cementitious material gets into the eye, rinse immediately and repeatedly POUR •
with water and get prompt medical attention. ❑ LACK OF HELP
KEEP CHILDREN AWAY. ❑ WHEEL BARROW JOB • • RETURN 73 RECEIVED BY ' TO PLANT
X .i --. • ❑ PUMP LATE/PROBLEMS
WATER ADDED AT CUSTOMERS REQUEST TEST CYLINDERS TAKEN ❑ OTHER TIME -
ALLOWED - • �. ,
t SLUMP ON ARRIVAL ❑ NO SUPERPLASTICIZER TIME c Itt,I.OYU :U. '.
' GALS. TO FULL LOAD ❑ YES Total amount added
�, I in gallons. USED
GALS. TO 2/3 LOAD ❑ YES ° ----- EXCESS
GALS. TO 1/3 LOAD ❑ YES , r Trial lo TIME •
TICKET # PLANT CUST. . DATE P.O. NUMBER ORDER TYPE ORDER BY • PHONE ' •
PROJECT #
3 _ 7CS( 1C CP4fl. et 12
7
272 1t CD :$1 Chaco . • (yy: E ARREE W (1om) 59W - 94a.
CUSTOMER # TAX SOLD TO ZONE SCHEDULED TRUCK # DRIVER NAME ,
CODE ARRIVAL
. 1C09137 ' C15$TIS HEIK9TR ENCAVRTOCVG II C' 10:313 353 00A1 SAVERY
p STD. BY TIME LOAD #
E 9 ®3SZO SVV G 3[ LE,' ;.FCR'TL1AEVD, O ::ilk '
I T ,OY VJEu S: i t I CUBIC YARDS RETURNED . CLEAN -UP YES . , NO (Explain)
V
0 PRE
E , 1,.. • „': POST 4E - N0;(Explain) ,'
R i \ . DE LI VERY.
d- 9 ,t • i, e,,, .t :REi19DUCT a , - c•.
3iSaniIt.PMs141 IK:SKSOfinf:iSSII nntlYLfSSE i f51 01.1 SLUMP QUANTITI F QTOTAL ,' PRODUCT • U /11,' UNIT'PRICE AMOUNT. ,
'c�
T4IN€a Fill_ .00 ,f CY GMs•
E& ?69BCrAs 3EHTAL FEE S : 6 & CY
-
S�GO s1LOAD FEE - 1 • 1 KM CV •
•
F�1EL SURCB- ('!-OCE 1 �� LSD �, ,
f ' • 'I
K. , •
1 • 6
A
p i
r
COMMENTS: '•
1 ,
, .
SUB TOTAL - '
TAX ”
WATER ADDED ON THE AUTHORITY OF � TOTAL - ' r r
READY MIXED CONCRETE CUSTOMER y / SAND & GRAVEL {4 , I•
v 4 1 .
7
' G GLACIER NORT FIWEST, INC. - DELIVERY TICKET
TERMS AND CONDITIONS t. I'.AYMENT: ell invoices ire due lot net payment by the last day ( he month following the month itt which the punhase was triode. APPLICABi.E cash discount
allowed if paid an or by the I Oth day of the month following date of chase, provided no prior invoices are past due. A monthly service charge of l.5% per month (I g "4.
per annum; shall be charged and paid on all past due balances. If a service charge is assessed, it must be paid together with all delinquent amounts. at Seller's option, in
order to maintain an open account with Seiler. If Buyer fails to make payment according to the terms and conditions contained herein. Seller shall not be obligated to make
any further deliveries .o Buyer, may elect hi ..ny time to cancel all or part of the unfulfilled order and proceed to ettorce all legal rights for collection of the delinquent
amount.
2. ACCEPTANCE: BUYER'S REQUEST FOR DELIVERY OF MATERIAL OR ACCEPTANCE OF MATERIAL CONSTiTUTES ACCEPTANCE OF
SELLER'S GENERAL TERMS AND CONDITIONS OF SALE.
3. WAIVER OF OBJECTIONS: Buyer waives any objections to charges assessed in Seller's Invoices unless Seller is notified by Buyer within 10 days of Buyer's receipt of
Seller's invoice.
4. DELIVERY CONDITIONS: All concrete deliveries will be made in concrete transit mixer trucks unless otherwise noted. The Buyer shall provide suitable access. road-
ways and approaches to points of delivery. If suitable roads, access or approaches are not provided, Seller may stop deliveries until the condition is remedied..ln the event
Buyer orders delivery beyond the curb line, Buyer shall indemnify and hold Seller harmless against all claims, loss, cost, damages, expense and liability•resulting from
damage to the premises. Buyer shall be liable for all damage to Seller's trucks caused by unsuitable access roadways or approaches to the point of delivery inciudit•ig with -
out,limitation, truck towing charges. Buyer agrees to handle all materials sujplied•b_y Seller in conformance with ASTM's requirements. Seller is not responsible for job
site conditions. Seller reserves the right to refuse to deliver materials to a job site under conditions the Seller deems adverse.
5. MATERIALS: All materials are produced to meet the applicable ASTM specifications. All tests of concrete must be made according to applicable specifications and by a
WABO (Y ashington Association of Building Officials) or an Oregon certified testing laboratory. Buyer shall bear the cost of inspection or testing made by or on behalf of
Buyer to determine compliance with ASTM specifications. .
6. DISCLAIMER OF WARRANTY: SELLER INTAKES NO GUARANTY OR WARRANTY OF MERCHANTA..B:ILiTY FITNESS FOR A PARTICULAR PURPOSE OR
t'SE, PERFORMANCE, EXPRESS, IMPLIED OR STATUTORY. SELLER SHALL EIAVE NO l..IABiL1TY FOR CONSEQUENTIAL, INCIDENTAL. LIQUIDATED
OR 6TI IE?R..DAMAGI: 11OWSOE'VER. CAUSED. SELLER'S LIABILITY IF.A,NY IS LIMITED 'FO THE REPAIR OR REPLACEMENT OF NONCONFORMING
MATERIAL. SFI:f;I i:`S OBLIGATION' TO REPAIR OR REPLACE NONCONFORMING MATERIAL. SHALL 'TERMINATE 60 DAYS AFTER DELIVERY OF
MATF I ALTO BUYER-, .
7. AD.DIIT1'.E.S: dudh ves. admixtures and other products are available at Buyer's sole expense and risk. Buyer expressly assumes all responsibility for ingredients added to
the concrete witiwut Sellers approcal. Sueh add ,:: shall void Seller's w rrant}{''ofthe material specifications.
8. (L:> ; }l. ": +S.:licr shall not li ( -• Q , r any nonconforming or defective materials unless I3uye.r promptly notifies Seller of the problem and Setter's
resp,,,,,- .;lay 's •p,•oven by -',...: la. ,hall not be liable for any special direct. indirect or consequential damages causecl by reason of said material's failure. defect or
• nonconr. 'tit••. t ". :tc;t: ., : - aity or defective materials or for any nil .er to t._- w•ta tsoever.shall he deemed waiv.:t by Buyer unless written notice is gr'c:n to
tr • -
*l6' ^ ; da attc:, dal: ri ■ ii• E.c r. Seller shall have a reasonable opportunity to investigate all claims. " . -. • '
._ .' S std UNtD SL.., R'S CONTROL: Seller shall be liable for delays to p.;;7or mance f:om any cause beyond Seller's control, including. but not limited
. ,o, 1-..,.. - ,r „quake , a •. rr other natural disaster labor stoppages, lockouts, smkes or other differences with employees: war, riot. or embargoes, failure to
secure Lii serials nec;sss - 'a -e' and production of those materials. or priorities :ty any governinent agency or authority. During the time of any such delay,
Seller Shall have the . i ^ to c'pporti.m among its various customers such material as Seller r ay manufacture and deliver. En no event shall Seller he liable for consequen-
: Al. special or inci.'.•'nral damages._ pi:eluding without. limitation, liquidated damages for d, :ay or failure to deliver material. Seller shall not be liable for any physical
. changes ar. flat- :age w the mate; "rl , :• red h; job delays, delivery systems, placing equipment. or any other circumstance beyond Seller's control.
+ • •
• Rt. i AXES:.I'- , , . quoted do nit , , federal, state or local sales or excise taxes.
,-
•
i I. MATERIA : • ' - .is ,: pi lee-- stated in Seller's Quote and invoices are based on 13uyers estimate of material quantity requirements. In the event that
Buyer fails to tat:c c . y u > of tr r' :a, or requests cancellation of a delivery after Seller's trucks are loaded or two hours before a scheduled delivery, Seller
may charge Buy for .t c cost of the material, including without limitation, Seller's cost of securing ingredients necessary for manufacture and production of the material
and any a .:osts eeeie led by Seller attributable to Buyer's cancellation. Seller is not required to provide more material than the estimated quantity of material contained
in Buyer's •rhas. (,der. Seller assumes no responsibility for any change in Buyer's order or quantity requirements. unless such change is confirmed in writing by Buyer
and accepted :. .✓n.ing by Seller. Any price variation resulting •iotn sue ' change sh,i ;l heeotne effective immediately upon Seller's acceptance of such change or as the
parties ma} oth . wise age ee .
12. COLLECT,t z .PEi :.• . gaily account is not paid when due. Buy-e• shall be liable to the Seller for all costs fees and expenses incurred in collecting the balance due.
Such expenses s a:,l include attorney's fees whether or not legal proceedings are instituted, and if instituted, shall include all other costs, fees. expenses and, including with-
out limitation, expert witness fees i , +rut. 1 in both the t•ial!arbitration and appellate proceedings.
13. INCORPORATION CLAUSE: A : ms and conditions contained in Sellers Quote Purchase Agreement /Credit Application and Invoices as now exist and as may be
modified, are expressly incorporate- '.r rein by this reference and made a part of the terms and conditions of this Delivery Ticket. The terms of Buyer's purchase order or
contract notwithstanding. all sales u : • Buyer are subject to Seller's General Terms and C :nnditions incorporated herein. In case ot'a difference or inconsistency between
Seller's General 'terms and Co' •+ir.• ., id Buyer's purchase order or contract form. Seller's General 'Terms and Conditions shall prevail.
Customer assumes full responsih •I'or ii:: weight of the load and for the ability.of vehicle to bear the weight of the load and for traveling over, across or on any road path
or enu-vway. Customer will d'tt'nu, ind • nntfy and hold Glacier Northwest harmless from any claim That may arise due to the transportation of materials purchased by cup.'
lamer.
• CUSTOMER SIGNATURE
WARNING
COMA". ;- ' : 'S ..ILY MIXED CERTENT Id•9.ORTAR, GROUT OR CONCRETE MAY CA.i:ISE SKIN BURN. AVOID DIRECT CONTACT
^;"'.uERwE - AND WASH SKIN AREAS WHiC.H HAVE BEEN EXPOSED TO SUCH CONTACT PROMPTLY WITH WATER.
IF ANY CL: its t NT OR MATERIAL CONTAINING CEMENT GETS INTO THE EYE, RINSE iMMEDIATELV AND REPEATEDLY WITH WATER
AND GET PRC: = :!PT NTEDiCAL ATTENTION. -
r KEEP OUT OF REACH OF CHILDREN
- Page 2 .
c q
' f f ! IIII II I II II II III I I II 1' A�' -
r ACT '
� + p } 1 C.-' l L -' Date 06 /30
Scheduled 0 Contract Services Work Order # WO111131
ar-~ / 08:00:00 River City E- nv[iro LrnetntaLI,, inc. .•
503- 252 -6144 Complete Industrial
P.O. Box 30087 ' Salem 503- 363 -2464 Vancouver 360- 896 -5256 Waste Removal
Septic Tank Cleaning
Portland, OR 97294 Sump Line Cleaning
4 , . , z , , �` vigil, orma vx • c r .f a f,
r wG� � S;' � r a.a
Curtis Heintz Excavation Curtis Heintz Excavation
PO Box 1105 10195 SW Kable St Tigard, 97224
Sherwood, OR 97140
Contact: Jim Brown 503 - 519 - 1869 cell
503 - 519 -8409 cell PO#
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Septic Service - - c c 1 oc00 . ry, f
Septage Overage 7- c ' @ ” 00
Notes Darren - 503 - 519 -8409 on site Pumping for decommissioning.) • - •
on site at 8:OOAM ' -
. . pui/cLio /006 , 2, 5 ,., ,,
Fhzq Pi ( r l s s7 �
•
•
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Total Charges _, c- r- c r ,
River City Environmental, Inc. is in no way responsible for damage to any vehicles, personal or real property.
Terms: Net 10 days. 1.5% per month will be charged on past due accounts (18% per annum).
Terms and Conditions The Right to Lien
The customer agrees to pay all invoices arising out of services, and any other special services herein within 10 days.
The customer agrees to pay such extra and overtime charges as may be invoiced from time to time for services rendered, over and above the normal servicing .
schedule, on behalf of the customer.
The customer agrees to assume responsibility damage to customers real or personal property arising from services which take place
on customers premises, where the drivers and vehicles of River City Environmental, Inc. have been instructed to enter.
This includes, but is not limited to driveways, trees, power lines or poles and building structures.
If River City Environmental finds it necessary to add liquid to the tank on jobsite, customer will be charged for the additional gallonage resulting from these condidtions.
Customer agrees to reimburse River City Environmental for all reasonable attorney's fees court costs and other expense incurred by said company to enforce
collection or to serve their rights under this agreement.
If this work order is not contested in writing within 10 days the full amount is considered due and payable.
Customer agrees to the above conditions. A fax on the work order is considered an original. Redeemable in Multnomah County
Check # Visa MC Amex Card # Exp Date Vcode
Work Authorized by (please print) — / /i i .i i C� `.r . ; Date /(: // 0J
Signature — - _'„"-•' -'`-- __
Service = #1 /� Service Tech #2 Date /4, 1/ U Time ry. i d/4,j
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GEOPACIFIC ENGINEERING, INC. 13910 SW Galbreath Dr. Ste. 102
Sherwood, Oregon 97140
Phone: 503 - 625 -4455 • Fax 503 - 625 -4405
Special Inspection
JOB #
DAILY FIELD REPORT `
PROJECT /Ff ii) ,t: U' & DAT - 7%3 // 0
V /
JOB ADDRESS I a / 7/ TYPE OF INSPECTION T' Lein& - zi74/4•6da�
PERMIT NO. WEATHER 6vt —cars /-
Inspection Notes: (Include location, testing date, substitutions / deviations, materials, methods of construction,
conformance
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.2 Observed by:
Information contained herein perts t materials tested /inspected only. The fact that any particular work has been
observed or tested not waive the contractor's responsibility for the means and methods of construction, job site
safety, or to comply with the contract documents.
•