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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 this certificate, who is a recognized authority of <br />p <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 />. Excess water is detrimental to concrete quality. Increased water in concrete mix reduces strength and durability and increases shrinkage. <br />NOTE <br />Buyer accepts responsibility for water added on job site, which exceeds accepted water/cement ratio and workability specifications. <br />Plant: <br />Begin Loading: <br />To Job: <br />Arrive Job: <br />Start Unload: <br />Finish Unload: <br />Leave Job: <br />Return Plant: <br />QUANTITY <br />Total Amount for This Ticket Not Including Standby Charges: <br />Cash Check # / Auth Code: <br />Check <br />Charge <br />Signature of Driver Receiving Cash: <br />Cash Received: <br />Total COD Order Amount to Collect <br />Without Standby Charges: <br />Customer Code: Customer Name: <br />Project Code: Project Name: <br />Ticket Date: Delivery Address: <br />Delivery Instructions: <br />Due On Job: <br />Slump: <br />Deputy Weighmaster: <br />Order P.O. Number: <br />LOAD <br />CUMULATIVE <br />QUANTITY <br />QUANTITY <br />Load: Truck Number: <br />ORDERED MATERIAL CODE <br />QUANTITY <br />Customer Job Number: <br />Order Code / Date: <br />Deputy Weighmaster: <br />Order P.O. Number: <br />Map Page: <br />Driver Number: I Driver Name: <br />PRODUCTION DESCRIPTION <br />Ticket Number: <br />End Use: <br />UOM I UNIT PRICE I AMOUNT <br />Water Added Curb Line Crossed At Owner's SUB TOTAL <br />IN GALLONS: Agent's Request: X <br />AUTHORIZED SIGNATURE <br />TAX <br />Print Name: Date <br />OSignature 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: 41,67.7317 <br />Tot, W.0'rim <br />120.9G gi 120.% <br />12. l g 1 202.00 -14.00 g l <br />Actltal 323,0 gl To Add: 97.0 gl <br />80UNIVERSAL Rev 4/12 <br />