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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 <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 />17CEMEX 41504853 <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: Job: <br />,--. <br />Arrive Start Unload: Finish Unload: Leave Job: Return Plant: <br />7t <br />Total Amount for This Ticket Not Including Standby Charges: <br />Cash Check # / Auth Code: <br />--I Check <br />Signature of Driver Receiving Cash: Cash Received: Total COD Order Amount to Collect <br />Without Standby Charges: <br />—1 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: Driver Number: Driver Name: End Use: <br />LOAD <br />QUANTITY <br />CUMULATIVE <br />QUANTITY <br />ORDERED <br />QUANTITY MATERIAL CODE PRODUCTION DESCRIPTION UOM UNIT PRICE AMOUNT <br />Water Added Curb Line Crossed At Owner's SUB TOTAL <br />IN GALLONS: Agent's Request: <br />AUTHORIZED SIGNATURE <br />TAX <br />Print Name: Date <br />Signature above signifies receipt 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: <br /> 4 1 50485„ <br />3. <br />-.0Ad Size Mix <br />50 CYDS 1 409 4c7'7 <br />ii i <br />29736863 <br />S eq Ti me Date <br />1'2%21 7/9 <br />Jerial Asign At; Required Batched Var % Var % Moisture <br />' COM 2175.0 lb 7986.18 lb 7960.0 lb -26.18 -0.33% 4.91% A <br />711E4T 968.00 lb 3388. N lb 3380.0 lb -8. tu, -0.24% <br /> <br />Et 0 gi 137.2 g 1 137.0 g 1 -.2 -0.16% <br />_ tual Num Batches: 1 Manual 12:21:16 <br />.,.d Total: 12483 lb Design 0.517 WateriCe.eent 0.448 R Design 210.0 g I. <br />—lip: 9.00 in # Ad just Water: 0.0 gl. l Load Trio Water:-8.0 g 1 i CYD <br />Act ua I Wat <br /> <br />Tot. Wat Tri a <br />44.63 g 1 <br /> <br />44.63 <br />137.0 g 1 <br /> <br />137.0 -8 .0 <br />Actual 181.6 Ti qdr2! <br />80UNIVERSAL Rev 4/12