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CONTROL NO. <br />` WE1GFiMASTER CERTIFICATE SOMe op THt PRooucrs THAT WE seu cou o CONTAIN y �_ <br /> f ONE OR MORE TO THE STATE OF <br /> THIS T6 CERTIFY that Ike IollowinA dea°rlNetl L°mmotlity was weipnatl,meas°ratl, 'ti✓ CALlf6RNIA TO CAUSE ClGANGER.819TH DEFECTS OR OYHER �LOQt READY MIX AND QHIVER OF TRUCK are rel, from any <br />°r Se 5 responsibility of addition to colors due to variations in cement and <br /> tl by a weighmaetBr,whose S,C"t ra is°°thl...0,icete,whe Is a rec°0nrzetl CAUTION: <br /> N:Fresh) aggregate materials or admixtures, and for damages which may be <br /> eee°,e^y:ae preSmlNetl by cN kt°r=I=°mm° "R with 5°°<'°^"'r°I°` CAUTION:Freshly mixed concrete may cause <br /> o Hle1Qasu amen Bt nEems of lne GalVlem�a l]eP rtmlmt of Food and Aasi �+��Y the g1Ylal°" skin irritation on prolonged exposure.Avoid <br /> incurred indellveringmaterialsacrossihecurborpropertyf'ine.Ctaims or <br />°• LOCI Ready MIX direct contact where possible and wash shortage will not be allowed unl/ass made at the Skme this material was <br /> exposed skin areas promptly with water.If any delivered. ! <br /> cementious materials get into the eye.rinse ADDITIONAL WATER ADDEDTO THIS CONCRETE WILL REDUCE <br /> TRANSIT MIX&BUILDING MATERIALS ITS STRENI <br /> NYWATER ADDED 1S AT CUSTOMER'S OWN <br /> 851 <br /> E.LODI AVE. P.O.BOX 3 • LODI,CA 95241 • (209)368-2794 immediately and repeatedly with water and get RISK. <br /> prompt medical attention. <br /> SOLD TO: Keep out of reach of children. REcewE <br /> LODI READY MIX ITE NY <br /> ❑ NO <br /> E• r* M I T0H4LEFd yIfE16NMASTER Added Gals.to full load ❑ vas <br /> On Joe <br /> PU RV I.ANNE ISR 7 I—LE RS WEIGHED ATI At Gals.to 21 load YES <br /> rr--55 customer's <br /> :.., j(_1t,1 L_. �.vF'101=� � 0IW.�a� -Request Gals.[o�/a load YES <br /> AUTHORIZED BY, <br /> BY' 1--• CAMP _LI,... DEPUTY I <br /> TIME TRUCK LIC. MAX.ADDWATERGALS. <br /> JOB CODE TRUCK NO. DRIVER ND NUMBER � ..� <br /> DATE <br /> 03 f a 1/9.0 07:54 1 WA ER SLU P <br /> NO.OF LOADS AGCUM.YARDS CU.YDS.THIS LOAD <br /> MIX NO. MIX ESCRIPTION <br /> (.)L i 9. 00r-10�} 9. 0 1111 111 SAND CASH SALE <br /> SPECIAL PRODUCT PRODUCT DESCHIPT$ON CU.YDS:THIS LOAD <br /> PRICE/CU.YARD <br /> t PRICE/LOAD l <br /> MIN.LOAD CHG. - <br /> k REASON FOR DELAY TIME: SUB-TOTAL <br /> Leave Plant Time on Jab Min, Joh Not Ready SALES TAX <br /> REV-COUNT / r TOTAL FOB PLANT <br /> —Arrive Job Overtime Min. Job Broke Down <br /> p - Ell Truck Broke Down SPEC.PRODUCTS <br /> REV.COUNT Per Min. <br /> Start Pour Rate of X$ � Adding Water TOTAL TAXABLE <br />{ TIME ON JOB /1 +� Arrived Job Early SALES TAX <br /> Stop Pour -$ Overtime Charge <br /> � Slow Placing Method OVERTIME <br /> Leave Job Five Other(Explain) <br /> (5)min.per yd.free unloading time allowed. TOTAL <br /> Additional unloading time charged at current ❑ <br /> hourly truck rate, <br /> Arrive Plant <br /> WA T F C RATI 0. 47 <br /> I . <br /> INSPECTION COPY <br />