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INVOICE WEIGHMASTER CERTIFICATE 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 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 of Measurement Standards CEMEX of the California Department of Food and Agriculture. 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: AUTHORIZED SIGNATURE Total Amount for This Ticket Not Including Standby Charges: Cash Check N / Auth Code: Check Charge Signature of Driver Receiving Cash: Cash Received: Total COD Order Amount to Collect Without Standby Charges: Customer Coae: customer Name: Customer Job Number: Urder Code / Date: Project Code: 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 QUANTITY QUANTITY QUANTITY MATERIAL CODE PRODUCTION DESCRIPTION UOM UNIT PRICE AMOUNT BATCH DATA 80UNIVERSAL Rev 4/12 r Water Added Curb Line Crossed At Owner's SUB TOTAL IN GALLONS: Agent's Request: l X1 AUTHORIZED SIGNATURE TAX X) Print Name: Date Signature above signifies receipt and acceptance of the listed materials and acknowledge- ment of and agreement to the CEMEX terms and conditions. TOTAL INITIALS INITIALS BATCH DATA 80UNIVERSAL Rev 4/12 r