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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 t by Ch eldwho is a recognized authority of <br /> accuracy,as presented by Chapter 7(commencing with Section <br /> 12700)of Division 5 of the California Business and Professions zzc C—M E X <br /> Code,spministered 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 strength and durability and increases shrinkage. <br /> 1 G Buyer accepts responsibility for water added on job site,which exceeds accepted water/cement 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#/Auth Code: Signature of Driver Receiving Cash: Cash Received: Total COD Order Amount to Collect <br /> Without Standby Charges: <br /> Chock <br /> Charge <br /> Customer Code: Customer Name: Customer Job Number: Order Code l Date: <br /> Project Code: Project Name: Deputy Weighmaster: Order P.O.Number <br /> Ticket Date: Delivery Morass: 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: v' Agent's Request: AUTHORIZED SIGNATURE <br /> TAX <br /> O Print Name: Data X O Signature above signifies receipt and acceptance of the listed materials and acknowledge- <br /> TOTAL <br /> INITIALS INITIALS ment of and agreement to the CEMEX terms and conditions. <br /> BATCH DATA: <br /> 8OUNIVERSAL Rev4/12 <br />