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CUSTOMER WEIGHMASTER CERTIFICATE THIS IS TO CERTIFY that the following described commodity was weighed, measured, or counted by a weighmaster, whose signature son this certificate, who is a recognized authority of accuracy, prescribed by Chapter 7 (commencing with Section Di 12700) of Division 5 of the California Business and Professions Code, administered by the Division of Measurement Standards Z/C C— M C— X 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 workabilitv soecificatlons Plant: Begin Loading: To Job: Arrive Job: Start Unload: Finish Unload: Leave Job: Re um Plant: Total Amount for This Ticket Not Including Standby Charges: Cash Check # / Auth Code: Check Charge Signature of Driver Receiving Cash: Cash Received: Total COD Order Amount to Collect Without Standby Chargee: Project Code: Project Name: Ticket Date: Delivery Address: Delivery Instructions: Due On Job: Slump: Load: Truck Number: LOAD CUMULATIVE ORDERED MATERIAL CODE QUANTITY QUANTITY QUANTITY customer JOD NumoeC uraer uooe / uate: Deputy Weighmaster: Order P.O. Number. Map Page: Driver Number: I Driver Name: PRODUCTION DESCRIPTION Ticket Number: End Use: UOM I UNIT PRICE I AMOUNT Water Added Curb Line Crossed At Owner's O SUB TOTAL IN GALLONS: Agent's Request: AUTHORIZED SIGNATURE TAX OPrint Name: Date INITIALS O INITIALS Signature above signifies receipt and acceptance of the listed materials and acknowledge- TOTAL ment of and agreement to the CEMEX terms and conditions. BATCH DATA 80UNIVERSAL Rev 4/12