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CUSTOMER <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 bdy C carillons,who is a recognized authority of <br /> accuracy,azure is n this atl by Chapter 7(commencing withauthority <br /> Section <br /> 12700)of Division 5 of the California Business and Professions ZZC=E M C—X <br /> Code,administered by the Division of Measurement Standards <br /> of the California Department of Food and Agriculture. <br /> NOTE: <br /> Excess water is detrimental to concrete quality.Increased water in concrete mix reduces st ength and durability and Increases shrinkage. <br /> 1 G Buyer accepts responsibility for water added on job site,which exceeds accepted watedcement ratio and workability specifications. <br /> Plant: Begin Loading: To Job: Arrive Job: Start Unload: Finish Unload: Leave Job: Return Plant: <br /> Total Amount for This Ticket Not Including Standby Charges: <br /> Cash Check M I Auth Code: Signature of Driver Receiving Cash: Cash Received: To at COD Order Amount to Collect <br /> Without Standby Charges: <br /> Check <br /> Charge <br /> Customer Code: Customer Name: Customer Job Number: Omer Code l Date: <br /> Project Cade: Project Name: Deputy Weighmastec Order,P.O.Number: <br /> Ticket Date: Delivery Address: Map Page: <br /> Delivery Instructions: Ticket Number. <br /> Due On Job: Slump. Load. Truck Number: Driver Number: Driver Name: End Use: <br /> LOAD CUMULATIVE ORDERED MATERIAL CODE PRODUCTION DESCRIPTION UOM UNIT PRICE AMOUNT <br /> QUANTITY QUANTITY QUANTITY <br /> Water Added Curb Line Crossed At Owner's O SUB TOTAL <br /> IN GALLONS: Agent's Request: AUTHORIZED SIGNATURE <br /> TAX <br /> Print Name: Date TOTAL <br /> O O Signature above signifies receipt and acceptance of the listed materials and acknowletlge- <br /> INITIALS INITIALS ment of and agreement to the CEMEX terms and conditions. <br /> BATCH DATA: _ <br /> SOUNIVERSAL Rev4/12 <br />