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CUSTOMER . <br /> r <br /> _ y 1 <br /> WEIGHMASTER CERTIFICATE <br /> THIS IS TO CERTIFY that the following described commodity <br /> was weighed,measured, a counted by a cognize authority <br /> whose ZZCC—MC—X <br /> 42375710 <br /> signature is on this certificate,who is a recognized authority of <br /> accuracy as prescribed by Chapter 7(commencing with Section <br /> 12700)of Division 5 of the California Business and Professions <br /> Code,administered by the Division of Measurement Standards <br /> of the California Department of Food and Agriculture. <br /> , Excess water is detrimental to concrete quality. Increased water in concrete mix reduces strength and durability a%d increases shrinkage. <br /> NOTE <br /> 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 /> -1 <br /> Total Amount for This Ticket Not Including Standbyharges: <br /> Cash Check#,'Auth Code: Signature of Driver Receiving Cash: Cash Received: Total COD Order Amount to Collect <br /> Check Without Standby Charges: <br /> Charge <br /> Customer Code: Customer Name Customer Job Number: Order Code/Date: <br /> Project Code: Project Name: Deputy Weighmaster: Order P.O.Number: <br /> Ticket Date: Delivery Address: Map Page: <br /> Delivery Instructions: Ticket Number. <br /> Due On Job: Slump: Load: Truck Number- Drive(Nnmhel Driver Name: End Use: <br /> LOAD CUMULATIVE ORDERED MATERIAL CODE PRODUCTION DESCRIPTION UOM UNIT PRICE AMOUNT <br /> QUANTITY OUANTITY QUANTITY <br /> y <br /> - r <br /> Water Added Curb Line Crossed At Owner's / ) ` .' SUB TOTAL <br /> IN GALLONS: Agent's Request: <br /> AUTHORIZED SIGNATURE <br /> TAX <br /> l-X) �X) Print Name: Date TOTAL <br /> Signature above signifies receipt and acceptance of the listed materials and acknowledge- <br /> INITIALS INITIALS ment of and agreement to the CEMEX terms and conditions. <br /> BATCH DATA: 42315-110 235-110 <br /> Rnl INI\/FRRAI Rp,r 4/12 <br />