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CUSTOMER <br /> WEIGHMASTER CERTIFICATE <br /> THIS IS TO CERTIFY that the fallowing described commodity <br /> was weighed,measured,or counted by a weighmaster,whose <br /> signature is on this certificate,who is a mmgn ing authority of <br /> accuracy,is n this cert by Chapter 7(commencing withauthority <br /> Section <br /> 12700)of Division 5 of the California Business and Professions zzc E M E X <br /> Code,administered by the Division of Measurement Standards <br /> of the California Department of Fmtl and Agnculture. <br /> NOTE. Excess water is detnmental to concrete quality.Increased water in concrete mix rectums strength and durability and increases shrinkage. <br /> C Buyer accepts responsibility for water added on job site,which exceeds accepted water/cement ratio and workability specifications. <br /> Plant: Begin Loading: To Job: Arrive Job: StartUnload: Finish Unload: Leave Job: Return Plant: <br /> Total Amount far This Ticket Nol Including Standby Charges: <br /> Cash Check#/Auth Code: Signature of Driver Receiving Cash: Cash Received: Total COD Order Amount to Collect <br /> Without Standby Charges: <br /> Check <br /> Charge <br /> Customer Code: Customer Name: Customer Job Number: Order Code/Date'. <br /> Project Code: Project Name: Deputy Weighmaster, OrderPO.Number: <br /> Ticket Date: Delivery Address: Map Page: <br /> Delivery Instructions: Ticket Number: <br /> Due On JobSlump', Load: Truck Number: Driver Number: Driver Name: End Use: <br /> LOAD CUMULATIVE ORDERED MATERIAL CODE PRODUCTION DESCRIPTION UOM UNIT PRICE AMOUNT <br /> QUANTITY QUANTITY QUANTITY <br /> Water Added Curb Line Crossed At Owner's O SUB TOTAL <br /> IN GALLONS: Agent's Request: AUTHORRED SIGNATURE <br /> TAX <br /> Print Name: Date TOTAL <br /> OO Signature above signifies receipt and acceptance of the listed materials and acknowletlge- <br /> INITIALS INITIALS ment of and agreement to the CEMEX terms and conditions. <br /> BATCH DATA: <br /> 8OUNIVERSAL Rev4/12 <br />