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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 weighmasleq whose <br /> signaturre is on title certificate,who is recognized authority of (( � /� <br /> accuracy,as escrbed b l <br /> Chapter 7 commencing4 with Section r r f <br /> 12700)of Division 5 of the California Business and Professions ZZC C <br /> Code,administered by the Division of Measurement Standards <br /> of the California Department of Food and Agricullurm <br /> NOTE. Excess water is detrimental to concrete quality.Increased water in concrete mix reduces strength and durability and increases shrinkage <br /> Buyer accepts responsibility,for water added on job site,which exceeds accepted water/cement ratio and workability specifications. <br /> Plant: Begin Loading: To Job: Anive Job: Start Unload: Finish Unload: Leave Job: Retum Plant: <br /> Total Amount for This Ticket Not Including Standby Charges: <br /> Cash Check k/Auth Code: Signature of Driver Receiving Cash: Cash Received: To al 0O0 Order Amount to Collect <br /> Without Standby Charges: <br /> Check <br /> Charge <br /> Customer Code: Customer Name: Customer Job Number: Order Code l 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: Dnver 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'sO SUB TOTAL <br /> IN GALLONS: Agent's Request: AUTHORIZED SIGNATURE <br /> TAX <br /> XO Print Name: Date TOTAL <br /> O Signature above signifies receipt and acceptance of Ne listed materials and acknowledge- <br /> INITIALS INITIALS maul of antl agreement to the CEMEX terms antl conditions. <br /> BATCH DATA: <br /> BOUNIVERSAL Rev 4/12 <br />