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CUSTOMER T <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 Division <br /> of the Chapter a(commencing with SectionzZaCAMM01114 <br /> S <br /> Code,)of Division 5 of the California Business <br /> Measurement <br /> and Professions <br /> Code,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 responsible;for water added on job site,which exceeds accepted water/cement ratio and workability specifications. <br /> Plant: Begin Loading: To Job: Arrive J b: Start Unload: finish Unload: Leave Job: Return Plant: <br /> Total Amount for This Ticket Not Including Standby Charges. <br /> Cash Check#/Auth Code: Signatureef Driver Receiving Cash: Cas=R,mvedTotal COD Order Amount to Collect <br /> ithout Standby Charges: <br /> Check <br /> Charge <br /> Customer Code: Customer Name: Customer Job Number: Order Cotle/Data: <br /> Project Code: Project Name: Deputy Weighmastec Order P.O. Number: <br /> Jyf Ticket Date: Delivery Address: Map Page: <br /> 7 Delivery Instructions: Ticket Number: <br /> Due On Job: Slump: Load: Truck Number: Oriv:1 Number: Driver Name: End Use: <br /> LOAD CUMULATIVE ORDERED MATERIAL CODE PRODUCTION DESCRIPTION BON UNIT PRICE AMOUNT <br /> QUANTITY QUANTITY QUANTITY <br /> I <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 rent of and agreement to the CEMEX terms and conditions. <br /> BATCH DATA: <br /> t <br /> I <br /> 80UNIVERSAL Rev4/12 <br />