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CORPORATE OFFICE 2091334-0790 <br /> ' C""t'E G- ooD CO. JACKSON VALLEY QUARRY 209!174.2016 <br /> CLEMENTS ROCK PLANT 209,759.3331 <br /> CLEMENTS HOT PLANT 209!759-3331 <br /> WEIGHMASTER FAX NO. 2091334-0796 <br /> 28808 <br /> WEIGHMIASTER CERTIFICATE <br /> THIS IS TO CERTIFY that the following dertribed commodity was weighed,measured,or counted by a weigh- <br /> master,whose signature is on this certificate,who is a recognized authority of accuracy,as prescribed by Chapter <br /> 7 (commencing with Section 12700) of Division 5 of the California Business and Professions Code,administered <br /> by the Division of Measurement Standards of the California Department of Food and Agriculture. <br /> BATE WEIGHED TIME SCALE LOCATION DEPUTY WEIGHMASTER `TICKET,NO_,,,, <br /> CUSTOMER NO. ORDER NO. ^,C S F.O. OTHER - - + <br /> nc y <br /> CUSTOMER-BILLING ADDRESS 'DELIVERY ADDRESS AND':INSTRUCTIONS <br /> •'., .. 1 .�i'}:• S'{T.LI ins :; 'e' i,k 5' SS>' <br /> CARRIER , TRUCK NO. TRUCK LICENSE NO. TRAILER'LIC. NO. TRAILER LIC. N <br /> :jr. iiltlhtl� ;L Cetib <br /> PRODUCT NO.,z ,, PRODUCT <br /> DRIVER_. .. GROSS LBS. NET TONS UNIT PRICE . ._ SUB-TOTAL, <br /> DELIVERED, TARE LBS., TODAY'S TOTAL,.TONS. HAUL RATE <br /> '_;L,;,. _• fin:i7 . �;,�5:,, <br /> PICKED-UP NET LBS.. n TODAY'S LOAD NO. SALES TYPE �: _ SALES TAX ..,.,... _ <br /> DRIVER'S SIGNATURE.. , .. - . .. ., �. <br /> TOTAL' <br /> K DUE <br /> The signature below by Customer or Customer's representative acknowledges the following by Customer: <br />{1)The receipt of the above materials;(2) hat all provisions set forth heron are part of the terms of sale. <br /> THE TERMS ON THE REVERSE! IDE O THIS DOCUMENT AAE AN INITIAL PART OF THIS SCALE TICKET, <br /> /rte r CLAUQE C.Wool)CO. <br /> RECEIVED BYX <br /> FORM 39(REV.8-90) DRIVERS COPY <br /> + <br />