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JIM BRISCO ENTERPRISES, INC Mailing Phone: (209)356-3275 Weighed at: Address: 221 Air Park Road, Suite A Dispatch: (209) 761-2280 14960 Vinewood Ave. Atwater, CA 95301 Livingston, CA 95334 SOLD TO: SHIP TO: LOAD t TO JOB ON JOB BEGIN POUR FINISH POUR TO PLANT O.T. MINUTES DATE PLANT# CUSTOMER# TRUCK# TYPE MATERIAL TICKET# MIX#-NAME/LOAD#-ACCUMULATED TOTALS YARDS WEIGHMASTER WATER ADDED: WEIGHMASTER CERTIFICATE THIS IS TO CERTIFY that the following described commodity was weighed,measured, or counted by a weighmaster,whose signature is on this certificate,who is a recognized authority of accuracy,as prescribed by Chapter 7 (commencing with Section 12700)of Division 5 of the California Business and Professions Code,administered by the Division of Measurement Standards of the California Department of Food and Agriculture. PRODUCT DESCRIPTION UNITS CEMENT Yd3 5 MINUTES 1 x 4 RK PER YARD FREE UNLOADING TIME ALLOWED. PEA RK Additional unloading SAND time charge at current hourly truck rate of $100.00 per hour. WATER O.T. Minutes Q $ /min= $ ADD MIX SUBTOTAL ADD MIX SALES TAX INSPECTOR'S ORDER TOTAL SIGNATURE DRIVER RECVD. BY ALL WEIGHTS ARE IN POUNDS UNLESS OTHERWISE SPECIFIED By signing this, or accepting the delivery and All claims for shortage or allowances must be made in writing within five days from date of delivery or service you accept our Standard Terms and WE MAKE DELIVERIESINSIDE CURB LINE AND ON THE LOT AT CUSTOMER'S RISK ONLY AND AC- CEPT NORESPONSIBILITY WHATSOEVER FOR DAMAGE RESULTING FROM SUCH DELIVERIES. Conditions of Sale, with or without signature. KEEP THIS DELIVERY TICKET FOR FUTURE REFERENCE BY: TERMS:All purchases not paid by the last day of the month following date of purchase shall incur a minimum of$2.00 service charge per month or 1'/:%per month finance charge, whichever is greater. 1'/z%per month is equivalent to an annual percentage rate of 18%. Buyer will pay reasonable costs of collection and attorney's fees.