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7/11 MATERIALS;INC. WEIGHMASTER CERTIFICATE WEIGHMASTER 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 P.O.BOX 4770 authority of accuracy,as prescribed by Chapter 7(commencing with Section 12700)of Division 5 of the California Business and Professions Code,administered by the Division MODESTO,CA 95352 of Measurement Standards of the California Department of Food and Agriculture. (209)529-4050 1; 17647 CONTROL NO. 0. 7 6 4 7 SOLD TO: -SHIP TO.: KEITH GROSS 1r-.1 LOUISE. AVE LATHROP PO BOX 178 0I it '7 TIME MIX NO. LOAD SIZE CU YD/METERS ORD D SLUMP PLANT/TRANSACTION TRUCK# DRIVER DATE CONTACT NO OF LOADS ACCUM CU YO/METERS ZONE PO.JOB# LICENSE# TICKET NUMBER QUANTITY CODE DESCRIPTION PRICE CU YD METER EXTENDED PRICE `,IV I ROMEN SUBTOTAL SALES TAX TOTAL PREVIOUS 160 1 CIA IPePPer AVEy STANDBY r ; WEIGHED AT: DEPUTY REV COUNT ARIV JOB ARIV PLNT LEFT JOB FIN POUR JOB NOT READY TRUCK BROKE DOWN Time Allowed JOB SITE CYLINDER TEST YES NO © 5 4 SLOW POUR OR PUMP ACCIDENT Water Added Gals to full load �YES TRUCK AHEAD ON JOB CITATION LEFT PLNT LEFT PLNT ARIV JOB ST.POUR Time Due On Job 2 3 CONTRACTOR UNAVAIL OTHER At Gals to 2/3 load YES ADDED WATER Customer's FIN POUR ITL RD TRIP TTL @ JOB POUR TIME JOB DELAY EXPLANATION Delay Time Request Gals to 1/3 load Ej YES Five(5)minutes per yd/meter free unloading time allowed. AUTHORIZED BY: Additional unloading time charged at current hourly rate. NOTICE:MY SIGNATURE BELOW INDICATES THAT I ACCEPT THE TERMS AND CONDITIONS OF THIS DELIVERY TAG INCLUDING THE TERMS AND CONDITIONS ON THE REVERSE,WE MAKE DELIVERIES INSIDE CURB LINES AND ON LOTS OR PROPERTY AT CUSTOMER S RISK ONLY AND ACCEPT NO RESPONSIBILITY WHATSOEVER FOR ANY DAMAGES RESULTING FROM SUCH DE- LIVERIES.CUSTOMER SHALL INDEMNIFY,HOLD HARMLESS&DEFEND 7/11 FOR,FROM&AGAINST ALL CLAIMS FOR DAMAGES OR PERSONAL INJURY.EXPENSE OF REMOVING MIRED TRUCK PAYABLE BY CUSTOMER.WE ARE NOT RESPONSIBLE FOR THE STRENGTH,SLUMP,OR QUALITY OF ANY CONCRETE TO WHICH WATER OR ANY OTHER MATERIAL HAS BEEN ADDED AT THE BUYER S REQUEST.WE DO NOT GUARANTEE THE COLOR OF THE CONCRETE.WE HAVE NO CONTROL OVER THE PLACING,FINISHING OR CURING OF CONCRETE AND DO NOT GUARANTEE THE FINISHED WORK IN WHICH IT IS USED,INCLUDING CRACKING.CONCRETE IS A PERISHABLE COMMODITYAND BECOMES THE PROPERTY OF THE PURCHASER UPON LEAVING THE PLANT.ANY CHANGES OR CANCELLATIONS OF ORIGINAL INSTRUCTIONS MUST BE TELEPHONED TO OFFICE BEFORE LOADING STARTS.CUSTOMER IS RESPONSIBLE FOR PRO- VIDING A SUITABLE PLACE,ON CUSTOMER S PROPERTY,FOR DRIVERS TO WASH CHUTES AS NECESSARY.ANY CLEANUP COST OF CUSTOMER-PROVIDED WASHOUT SITE OR REMOVAL OF TRACKED-MUD FROM STREETS AND ROADS WILL BE BILLED TO CUSTOMER. RECEIVED BY: 8 e� r st re Act, 1 W-t Lb jt ia.0 It) 604.0 1 b 2890.0 1 b -0.48% WAl L 50.00 gl 121.81 gl 121.75 gl -9.05% 121.75 gl HOT .0 % # .0 gl .0 gl W3 .d0 % # QW gl .00 g1 Actual Num batches: 1 Manual 12:32:38 Load Total: 99M lb Design 0.431 Water/Cesent 0.458 A Design 150.8 gl Actual 158.7 gl To Add: 0.0 91 Sloop: 8.00 in # Water in Truck: 0.0 gg1 Adjust Water: 0.0 gl / Load Trio Water: -1.0 1/ CYU Actual W/C Ratio: 0.458 Actual Water: 159 gl Batched Cesent: 2890 lb Allowable Wafer: 0 lb