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INVOICE WEIGHMASTER CERTIFICATE THIS IS TO CERTIFY that the following described commodity R was weighed,measured,or counted by a weighmaster,whose 4240 v signature is on this certificate,who is a recognized authority of accuracy,as prescribed by Chapter 7(commencing with Section ZZC � � 12700)of Division 5 of the California Business and Professions T Code,administered by the Division of Measurement Standards of the California Department of Food and Agriculture. r. .; . Excess water is detrimental to concrete quality. Increased water in concrete mix reduces strength and durability and increases shrinkage NOTE . Buyer accepts responsibility for water added on job site.which exceeds accepted water/cement ratio and workability specifications. Plant: Begin Loading: To Job: Arrive Job: Start Unload: Finish Unload: Leave Job: Return Plant: Total Amount for This Ticket Not Including Standby Charges: Cash Check a/Auth Code: Signature of Driver Receiving Cash: Cash Received: Total COD Order Amount to Collect Without Standby Charges: Check Charge Customer Code: Customer Name: Customer Job Number: Order Code/Date: Project Cdde: 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. LOAD CUMULATIVE ORDERED MATERIAL CODE PRODUCTION DESCRIPTION UOM UNIT PRICE AMOUNT QUANTITY QUANTITY QUANTITY Water Added Curb Line Crossed At Owner's SUB TOTAL IN GALLONS: Agent's Request: AUTHORIZED SIGNATURE TAX Print Name: Date 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: 4124.02977- 3/ rGA.029 ? .1 aisturz Pct ,a'_ i�at Tut.Wat T-�;; h' ti �3' A hc.69 g" c4 G^ y . 80LINIVERSAL Rev 4/12