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INVOICE <br /> WEIGHMASTER CERTIFICATE <br /> THIS IS TO CERTIFY that the following described commodity <br /> was weighed,measured,or counted by a weighmaster,whose <br /> signature is on this certificate,who is a recognized authority of _ _ 4 a 53712 <br /> accuracy,as prescribed by Chapter 7(commencing with Section L s.. <br /> 12700)of Division 5 of the California Business and Professions 4/4/C <br /> Cade,administered by the Division of Measurement Standards <br /> of the California Department of Food and Agriculture. <br /> NOTE, Excess water is detrimental to concrete quality. Increased water in concrete mix reduces strength and durability and increases shrinkage. <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 /> Total Amount for This Ticket Not Including Standby Charges: <br /> Cash Check#/Auth Code: Signature of Driver Receiving Cash: Cash Received: Total COD Order Amount to Collect <br /> Without Standby Charges: <br /> Check <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 Jab: Slump: Load: Truck Number: Driver Number: Driver Name: End Use: <br /> LOAD CUMULATIVE ORDERED MATERIAL CODE PRODUCTION DESCRIPTION UOM UNIT PRICE AMOUNT <br /> QUANTITY QUANTITY QUANTITY <br /> 0. GrtO 1 1 968L,b C. SFir�l1) <br /> 0. I l;l :12'47817 FUEL SURCHARBE <br /> 1.r►�i;?i 1`? ENVIRONMENTAL '71PRF F . <br /> Fa?r-�l_LJiIYci GET Our CI ND LOOK BEFORE BACKNING YOUR TRUCYt'.x y. <br /> +aMINDIUM LOAD CHAROE <br /> 0)--IAM C0l_t-1tei, I Concrete Di.spoi5al f=ee <br /> _ P,a r t i a 1 f-1-0.1 Load <br /> Water Added Curb Line Crossed At Owner's1 SUB TOTAL <br /> IN GALLONS: Agent's Request: CX) <br /> AUTHORIZED SIGNATURE <br /> - - TAX <br /> Print Nwme: Date <br /> (,X) (.X) Signature above signifies`teceipt and acceptance of the listed materials and acknowledge- TOTAL <br /> INITIALS INITIALS ment of and agreement to the CEMEX terms and conditions. <br /> BATCH DATA: a ,�j <br /> 1r•r_tc lrt• ke t, '.,.�_l 'iJ RI ) .� . _. <br /> ,F CI <br /> .0 0 J,07 44'� 2874_7864 1 G•'1: :Oy 11 2 ? 1 SI <br /> i__o,=xdll 13 i z E Mi >: l'ode:� <br /> P1�ttera.a:LDFsi.C�lt;ydi" 5F?E�cltairec:l ltat;ctic��l t.iarar-• y1y1oJ. 5t ur,Act,i_1aWj0, <br /> NdSCON 2175.06 1 b 13809.80 lb 13940.410 lb a 130.20 0.q4% 5.82% P 91.91 gl 91.91 <br /> CEMENT 9&5.ft lb 5848.00 lb 5780.0Ai Ib -28.00 -0.48% <br /> WATER U.Ngal 2@2.95 gal. 202.00 gal # -,.95 -0.47% 202.N y1 202.00 -11.00 gi <br /> °uai Nus Bafehes. 1 Manual 10:05:29 <br /> >d Taal: 21400 111 Design 6.517 Nater/Cement 0.42+ A Desi n 360.0 gl Actuil 293.9 gl 'o Add: K.1 y: <br /> m�: gs in Ac!Just Water: 0.0 gl i Load Trio N3ter•:-11.0gl I CVD <br /> &rUNIVF=Pq01 11Qv 4/12 <br />