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GALA VERA S• Delivery Tag <br /> NEIDELBERGCEMENT Group <br /> Weighmaster Certificate CUSTOMER COPY 2 <br /> Calaveras Materials Inc. PLAN I :34 MAN i'LLA <br /> 7673 N. Ingram Avenue t <br /> RD <br /> Fresno,CA 93711-5838 B4f)-676-3201 <br /> Phone 559-277-7060 <br /> Toll Free 800-726-5615 <br /> Load Leave Plant Arrive Job Start Pour End Pour Leave Job Arrive Plant <br /> Water Added on Job at Customer <br /> Customer's Request Gallons Signature X <br /> WEIGHMASTER CERTIFICATE: THIS IS TO CERTIFY that the following described commodity was weighed,measured,or counted by a weightmaster,whose <br /> signature is on this certificate, who is a recognized authority of accuracy, as prescribed by Chapter 7 (commencing with Section 12700) of Division 5 of the <br /> California Business and Professions Code,administered by the Division of Measurement Standards of the California Department of Food and Agriculture. <br /> DETAILEDCAUTION: PORTLAND CEMENT IS INJURIOUS TO EYES: CAUSES SKIN IRRITATION. READ WARNING ON REVERSE SIDE OF THIS FORM FOR <br /> INSTRUCTIONS. <br /> Plant Ticket No. Order No. Customer No. Sold To: Date <br /> Delivery Address Zone Driver <br /> t lel F9 RP }tn►��r{ rr, +�'�}T4a HrRo—F_S <br /> Special Instructions Project No. <br /> Special Instructions Job Number <br /> Truck No. Load Size Mix Code Slump %Air %Call. Project Name: <br /> Load Cumulative Ordered Unit of Product Product Unit Amount <br /> Quantity Quantity Quantity Measure Code Description Price <br /> 7 t4 iW Vfit.1 ItJ, i 5 S44r,4ir <br /> CACARB CA. CARP/ENV I.R ONM <br /> CALAVERAS MATERIALS INC.ASSUMES NO CERTIFICATE OF COMPLIANCE: WE CERTIFY that the <br /> RESPONSIBILITY FOR DAMAGE INCURRED IN portland cement,chemical and mineral admixtures contained in <br /> DELIVERING MATERIALS INSIDE THE CURB LINE. the material described below are brands stated and comply with <br /> specifications: <br /> CALAVERAS MATERIALS INC. CEMENT BRAND: Sub total <br /> TYPE: II MILL LOCATION: Tax <br /> CHEMICAL ADMIX BRAND: TYPE: <br /> MANUFACTURER: <br /> By — MINERAL ADMIX MANUFACTURER: <br /> CLASS: <br /> Total <br /> CONTROL <br /> NO. DO NOT USE FOR TICKET NO. <br /> FORM s WC (Rev,6106)X289327 <br />