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CUSTOMER <br />WEIGHMASTER CERTIFICATE <br />Begin Loading: <br />THIS IS TO CERTIFY that the following described commodity <br />Arrive Job: <br />was weighed, measured, or counted by a weighmaster, whose <br />signature is on this certificate, who is a recognized authority of <br />! k,^q� }��^( <br />(/1 739633 <br />4 1 3 <br />accuracy, as prescribed by Chapter 7 (commencing with Section <br />Return Plant: <br />• +. J L V <br />12700) of Division 5 of the California Business and ProfessionsZZCC—MC—X <br />Code, administered by the Division of Measurement Standards <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 />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 />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 />t,us[omer Looe: Cusromer Name: Customer Job Number: Urder Gode / 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 CUMULATIVE ORDERED MATERIAL CODE PRODUCTION DESCRIPTION UOM UNIT PRICE AMOUNT <br />QUANTITY I QUANTITY QUANTITY <br />Water Added Curb Line Crossed At Owner'sSUB TOTAL <br />IN GALLONS: Agent's Request: X <br />AUTHORIZED SIGNATURE <br />TAX <br />O O 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: 4 q 33.* g r 3 3 <br />80UNIVERSAL Rev 4/12 <br />