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CUSTOMER <br /> WEIGHMASTER CERTIFICATE <br /> THIS IS TO CERTIFY that the following described commodity 42913204 <br /> �jj q/ <br /> was weighed, measured,or counted by a weighmaater,whose fi}2 913 2 0 4 <br /> signature is on this tediby Ch who is a mmencing authority ofzzCC_MC_X <br /> accuracy,is 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 /> NOTEE 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 watedoement ratio and workability specigcetions. <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 4/Aulh 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 l Date: <br /> Project Code: Project Name: Deputy Weighmasler: Order P.O.Number: <br /> Ticket Date: Delivery Address: Map Page: <br /> i <br /> Delivery Instruclicns: Ticket Number: <br /> i <br /> Due On Job: Slump: Load: Truck Number: Driver Number: Driver Name: End Use: <br /> I LOAD CUMULATIVE ORDERED MATERIAL CODE PRODUCTION DESCRIPTION UOM UNIT PRICE AMOUNT <br /> I QUANTITY QUANTITY QUANTITY <br /> rif.'1 <br /> f..I... <br /> Water Added Curb Line Crossed At Owner'sO SUB TOTAL <br /> IN GALLONS: Agent's Request: <br /> AUTHORIZED SIGNATURE <br /> TAX <br /> O X <br /> Signature above signifies <br /> Name: Data <br /> ignifies mcafpt and acceptance.of the listed materials and acknowledge- TOTAL <br /> INITIALS INITIALS ment of and agreement to the CEMEX terns and conditions. <br /> BATCH DATA: 4 2 r, .3 2 0 4 <br /> r. <br /> OOUNIVERSAL Rev 4/12 <br />