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INVOICE <br />WEIGHMASTER CERTIFICATE <br />THIS IS TO CERTIFY that the following described commodity <br />was weighed, measured, or counted by a weighmaster, whose _ <br />signature is on this certificate, who is a recognized authority of " " <br />v p y (commencing ZZCC—MC—X 4lJ00 <br />accuracy, as prescribed b Chapter 7 commencin with Section <br />12700) of Division 5 of the California Business and Professions <br />Code, administered by the Division of Measurement Standards <br />of the California Department of Food and Agriculture. y GA 1-15-377 <br />ON h <br />NOTE . Excess water is detrimental to concrete quality. Increased water in concrete mix reduces strength and durability and increases shrinkage. <br />Buver accepts responsibility for water added on job site, which exceeds accepted water/cement ratio and workability specifications. <br />Plant: <br />Begin Loading: <br />To Job: <br />Arrive Job: <br />start Unload: <br />Finish Unload: <br />Leave Job: <br />Return Plant: <br />Total Amount for This Ticket Not Including Standby Charges: <br />Cash <br />Check # / Auth Code: <br />Signature of Driver Receiving Cash: <br />Cash Received: <br />Total COD Order Amount to Collect <br />Without Standby Charges: <br />Check <br />Charge <br />Customer Coae: i.usiomer Name. <br />Project Code: Project Name: <br />Ticket Date: Delivery Address: <br />Delivery Instructions: <br />Due On Job: Slump: Load: Truck Number: <br />LOAD CUMULATIVE ORDERED MATERIAL CODE <br />QUANTITY I QUANTITY QUANTITY <br />Deputy Weighmaster: Order P.O. Number: <br />Map Page: <br />Driver Number: I Driver Name: <br />PRODUCTION DESCRIPTION <br />Ticket Number: <br />End Use: <br />UOM I UNIT PRICE I AMOUNT <br />Water Added Curb Line Crossed At Owner'sO ; . SUB TOTAL <br />IN GALLONS: Agent's Request: AUTHORIZED IGNATURE <br />TAX <br />Print Name: Date TOTAL <br />O O Signature above signifies receipt and acceptance of the listed materials and acknowledge - <br />INITIALS INITIALS ment of and agreement to the CEMEX terms and conditions. <br />BATCH DATA: <br />P t+fL4 <br />I <br />50.- 02 Ai 16/' 16 <br />1)ar%VEii %moistl.,y-Act uawat 'rot. WaTr,inl <br />".02.01 18.47% 6.74% A 163.50 gl 163.50 <br />X3.00 gl 321N ALM it <br />pl!jfjln! 4AP.9 pl Tr, Add- R3.5 n; <br />80UNIVERSAL Rev 4/12 <br />