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CUSTOMER <br /> WEIGHMASTER CERTIFICATE <br /> THIS IS TO CERTIFY that Me following described commodity <br /> was weighed,measured,w counted by a weighmaster,whose <br /> signature Is on tNs bed by Ch who is a recognized authority of <br /> accuracy,is n mis cert by Chapter 7(commencing with Section C— _ <br /> 12700)of Division 5 of the California Business and Professions zzc <br /> Code,administered by the Division of Measurement Standards <br /> of the California Department of Food and Agriculture. <br /> NOTE: <br /> Excess water is detrimental to concrete quality.Increased water in concrete mix reduces strength and durability and increases shrinkage. <br /> 1 C Buyer accepts responsibility for water added on job site,which exceeds accepted waterlcement ratio and workability specifications. <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#IAuth Code: Signature of Driver Receiving Cash: Cash Remit Total COD Order Amount W Collect <br /> Whhout Standby Charges: <br /> Check <br /> Charge <br /> Customer Code: Customer Name: Customer Job Number: Cotler Code l Date'. <br /> Project Code: Project Name: Deputy Weighmaster: Order P.O.Number: <br /> Ticket Date: Delivery Address: Map Page'. <br /> Delivery Instructors: 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 QUANTITY I QUANTITY <br /> Water Added Curb Line Crossed At Owner's O SUB TOTAL <br /> IN GALLONS: �, Agent's Request: AUTHORIZED SIGNATURE <br /> TAX <br /> Print Name: Date <br /> O O Signature above signifies receipt and acceptance of the listed materials and acknowledge- <br /> TOTAL <br /> INITIALS INITIALS ment of and agreement to the CEMEX terms and conditions. <br /> BATCH DATA: <br /> BOUNIVERSAL Rev 4112 <br />