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THIS IS TO CERTIFY that the following described commodity was weighed,measured,or <br /> counted by a weighmaster,whose signature is on this certificate,who is a recognized authority <br /> of accuracy,as prescribed by Chapter 7(commencing with Section 12700)of Division 5 of the A Z <br /> California Business and Professions Code,administered by the Division of Measurement V V <br /> Standards of the California Department of Food and Agriculture. <br /> PEARSONS CONCRETE <br /> C10284��lO� 10284 UNDERWOOD RD., ACAMPO, CA 95220 <br /> /y TELEPHONE (209) 334-9234 <br /> Freshly mixed cement, mortar, <br /> concrete or grout may cause skin <br /> ORDER NO. DATES 200 <br /> injury. Avoid contact with skin where CUSTOMER - ;- <br /> possible and wash exposed skin h.. <br /> areas promptly with water. If any ,t 7 <br /> cement mixtures get into eyes, rinse '` <br /> DRIVER I.� TRUCK LOAD CU YD13< <br /> immediately and repeatedly with "�' <br /> CONCRETE MIX START TIME <br /> water and get prompt medical <br /> attention. - CEMENT ARRIVE JOB <br /> ADMIX 1 <br /> KEEP OUT OF REACH OF CHILDREN. A-1 LEAVE JOB <br /> t f A-2 END•T E <br /> ADMIX 2 <br /> A-3 T <br /> i <br /> A-4 FREE <br /> :# <br /> Dear Customer. U NET <br /> THIS LOAD SACK WEIGHED AT <br /> GUARANTEED UBIC ,P 3 C - MIX <, a 901 SIMMERHORl' <br /> NOTICE: WE MAKE DELIVERIES INSIDE THE CURB LINE TO YIELD Y DS CR E NO. / ^ GALT,CA. <br /> AT CUSTOMER'S RISK ONLY AND ACCEPT NO PEARSONS DY MIX CO CRETE INC.=WEIGHMASTER <br /> RESPONSIBILITY WHATSOEVER FOR DAMAGES BY <br /> RESULTING FROM SUCH DELIVERIES. - QUANTITY UNITS DESCRIPTION UNIT PRICE AMOUNT <br /> I � l <br /> The driver of this truck,in requesting the additional signature below,is of the opinion CU YDS CONCRETE <br /> �- that the size and weight of the truck may possibly cause damages to tho premises y. <br /> and/or adjacent property if the driver places the material in this load where you desire <br /> it.It is our wish to help you in every way that we can,but in order to do this,the driver <br /> is requesting that you or your representative sign below indicating you have released t the driver and PEARSONS CONCRETE from all responsibilty for any damage that if <br /> may occur to the premises and/or adjacent property,buildings,sidewalks,driveways, s <br /> curbs, etc. by the delivery of this material. Further,as additional consideration, you <br /> agree to help the driver remove mud from the wheels of the driver's vehicle so that <br /> the driver will not litter the public street, and you agree to indemnity and hold <br /> harmless the driver of this truck and PEARSONS CONCRETE for any and all liabilities MIN. STAND BY TIME <br /> and damages to the premises and/or adjacent property which may be claimed by <br /> " anyone to have arisen out of delivery of this order. HOURS RENTAL <br /> 5 MINUTES PER YARD FREE CHARGE C.O.D. <br /> {7 Signature: UNLOADING TIME ALLOWED TOTAL <br /> : ERRORS IN PRICE EXTENSION AND ADDITION SUBJECT TO CORRECTIONS <br /> 4 TERMS: Net 30 Days.One and one-half(11/2%)percent per month will be charged on past due accounts <br /> Any reasonable legal fees incurred in collection of above will be added to this charge. <br /> Received By: X <br /> GERMANY BROTHERS PRINTING — REV.9/01 <br />