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CUSTOMER WEIGHMASTER CERTIFICATE THIS IS TO CERTIFY that the following described commodity was weighed,measured,or counted by a weighmaster,whose signature is on this certificate.who is a recognized authority of + �(�y 1 7 cy,Di prescribed by Chapter 7(commencing with Section F= 1270�j of Division 5 of the California Business and Professions ZZ CEMEX Code,administered by the Division of Measurement Standards of the California Department of Food and Agriculture. It NOTE: Excess water is detrimental to concrete quality. Increased water in concrete mix reduces strength and durability and increases shrinkage. Buyer accepts responsibility for water added on job site,which exceeds accepted water/cement ratio and workability specifications. Plant: Begin Loading: r To Job: Arrive Job: Start Unload: Finish Unload: Leave Job: Return Plant: Total Amount for This Ticket Not Including Standby Charges: Cash Check#/Auth Code: Signature of Driver Receiving Cash: Cash Received: Total COD Order Amount to Collect Check Without Standby Charges: Charge Customer Code Customer Name: Customer Job Number: Order Code/Date: Project Code: Project Name: Deputy Weighmaster: Order P.O.Number: Ticket Date: Delivery Address: Map Page: Delivery Instructions: Ticket Number: Due On Job: Slump: Load: Truck Number: Driver Number: Driver Name: End Use: LOADCUMULATIVE ORDERED MATERIAL CODE PRODUCTION DESCRIPTION UOM UNIT PRICE AMOUNT QUANTITY OUANTITY QUANTITY K Water Added Curb Line Crossed At Owner's O SUB TOTAL IN GALLONS: Agent's Request: X AUTHORIZED SIGNATURE TAX Print Name: Date r� CX> O Signature above signifies receipt and acceptance of the listed materials and acknowledge- TOTAL INITIALS INITIALS ment of and agreement to the CEMEX terms and conditions. BATCH DATA: , 4 y 1 80UNIVERSAL Rev 4/12