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CUSTOMER <br /> WEIGHMASTER CERTIFICATE <br /> THIS IS TO CERTIFY that the following described commodity <br /> was weighed,measured,or counted by a weighmaster,whose <br /> signature is on this certificate,who is a recognized authority ofC�� <br /> Di <br /> accuracy. prescribed Chapter 7(commencing with SectionZZCC_MC_X <br /> { _ f�.) <br /> 12700)of Division Sof thehe California Business and Professions <br /> Code,administered by the Division of Measurement Standards <br /> of the California Department of Food and Agriculture. <br /> , Excess water is detrimental to concrete quality. Increased water in concrete mix reduces strength and durability and increases shrinkage. <br /> NOTE <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: Arrive J2,p: Start Unload: Finish Unload: Leave Job: Return Plant: <br /> Total Amount for T is Ticketf4ot Including Standby Charges: <br /> I Cash Check#/Auth Code: Signature of Driver Receiving Cash: Cash Received: Total COD Order Amount to Collect <br /> Check Without Standby Charges: <br /> Charge <br /> Customer Code: Customer Name: Customer Job Number: Order Code/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: Driver Number: Driver Name: End Use: <br /> LOAD CUMULATIVE ORDERED MATERIAL CODE PRODUCTION DESCRIPTION UOM UNIT PRICE AMOUNT <br /> QUANTITY QUANTITY QUANTITY <br /> .. i..I Ll <br /> r , <br /> 1.�-.4? 1—/ F='IJk I_ :�;j_1F'.I'Hfaf?re:: EF <br /> 0., 00 1202 7 4`-i Eh.1Y T R 1ti1&Q1 tL. C:1-AR Er <br /> -i <br /> CE=T OUT A1`41) t..r:fOK B •ORE E ACK) \1j73 YOUR TRUCI' <br /> M I N I PI I M I_.O R I.:{ <br /> r;;t-tr_r rati1. 1-F <br /> Water Added Curb Line Crossed At Owner's O SUB TOTAL <br /> IN GALLONS: Agent's Request: X <br /> AUTHORIZED SIGNATURE <br /> � TAX <br /> --� Print Name: Date <br /> r_X (X/ Signature above signifies receipt and acceptance of the listed materials and acknowledge- TOTAL <br /> INITIALS INITIALS ment of and agreement to the CEMEX terms and conditions. <br /> BATCH DATA: <br /> .cj S E C, 4,.., 5 <br /> arerlal Design 9 t v Regi.�ired 2,atched Vat- {Jar K �1914C+r_ Actilal Wat T9t.Wat Tr_ <br /> d'3CDM 2175.100 lb 462E.69 1b +640.00 1b -6.69 -11.14' 5.36% A 332.i1 <br /> CEMENT 968.130 1 b "936.00 'b ;'955.00 1.b 19.00 0.985 <br /> CATER 60.00 gal j 710.84 ga'! 69,00 gal -i.13L 69,00 g1 E9,00 -9.00 g: <br /> "jai Niis Batches Nan;Q] 13:18:37 <br /> ad T„tai: 7'51 1b Design 0.51.7 Water Tevert 0.4.36 A Design 120.0 g .11.1.,1 10L gl. To Add; <br /> rlp: ?.00 In # A01St Water: 0.0 gl L.9ad Trio mater:-5,ki g! GiD <br /> 80LINIVERSAL Rev 4/12 r4 <br />