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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 r <br /> signature is on this certificate,who is a recognized authority of 4 5 3 yr <br /> accuracy,as prescribed by Chapter 7(commencing with Section ..f.L 5 1 7 <br /> 12700)of Division 5 of the California Business and Professions C C m C x ` <br /> Code,administered by the Division of Measurement Standards 3 <br /> of the California Department of Food and Agriculture. - <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 /> t <br /> Plant: Begin Loading: To Job: Arrive Job: Start Unload: Finish Unload: Leave Job: Return Plant: <br /> Total Amount for This Ticket Not Including Standby Charges: <br /> Cash Check#/Auth Code: Signature of Driver Receiving Cash: Cash eceived: Total COD Order Amount to Collect <br /> 1 Without Standby Charges: <br /> Check I <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 7 CUMULATIVE ORDERED MATERIAL CODE PRODUCTION DESCRIPTION UOM UNIT PRICE AMOUNT <br /> QUANTITY1 QUANTITY QUANTITY <br /> 0. �!' 0 124�_.. <br /> 0 0O i20 :`.49 N Y!I R0N01c4'I''1'1'f'il... r-;.IP <br /> �,.*Fli. 1,-_f¢:I,, :, OE'T OUT F:--ii-, I._l:-n_ih; �tF:F"i� ;6 r-,•; tr r Rlt-i v rji ;� i �I ori,._. <br /> Water Added Curb Line Crossed At Owner's l SUB TOTAL <br /> IN GALLONS: Agent's Request: �X) <br /> AUTPORIZED SIGNATURE <br /> TAX <br /> Print Name: Date TOTAL <br /> X) (X) Signature above signifies receipt and acceptance of the listed materials and acknowledge- <br /> INITIALS - INITIALS ment of and agreement to the CEMEX terms and conditions. - <br /> BATCH DATA: <br /> .ra._ ..1 "tW'. <br /> rte_tg9 ��'t�hei: y3r <br /> ;'`.13E b cv �u,8a -b 2�5D2.N1 lb -..SEr.$A -12. <br /> 9468.IV `b ib 870@.N lb - 2M -k. . <br /> "e.N 1�qa.t 1'?8,,O✓_�gni 377,N g'.1 -i.IA6 <br /> TA1: c�Kl:, lb Ue5igr 0.517 W,-.ter'Ce®ent 0074 A <br /> 00 in Adp.t_t 148teF- 0.0 g1 r,ad Tri® u!ater:-5.0 g!. CIL <br /> 80UNIVERSAL Rev 4/12 �' <br />