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CUSTOMER <br /> WEIGHMASTER CERTIFICATE t <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 of 4a r <br /> r ( <br /> accuracy,as prescribed by Chapter 7(commencing with Section <br /> 12700)of Division 5 of the California Business and Professions <br /> Code,administered by the Division of Measurement Standards <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 /> 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 Received: Total COD Order Amount to Collect <br /> Without Standby Charges: <br /> Check <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 /> r <br /> SAND,, <br /> t 1.c_'1�► '7�r S PAV I RZON rlENTAL. C#•LARGE.= EA <br /> GEST 0IL)T i';1,iti =-- ±Cil! SE=FORE.: '?ACKTNIG `,OOR 'TRUCV <br /> .,)r~!!.m ?_ 0I_[Tit c i'"r~tf_'i 1"1t:_3~E�' ' 1%T t �t!)5c11 Fee <br /> ti <br /> !c:� � F <br /> .; ,�',e_, <br /> _�,._� .... r<i~j:: ,i,Fil FI_tl. .. Lo,-Rd <br /> Water Added Curb Line Crossed At Owner's SUB TOTAL <br /> IN GALLONS: Agent's Request: X <br /> AUTHORIZED SIGNATURE <br /> TAX <br /> Print Name: Date <br /> l 1CJ 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: y/! 2 6•7 6 7 g r <br /> i,�IL�lf,jar:''Ic UctCf ( t.?(ftP't.r' G1 J <br /> :n j. i'i. . „ ksi' !...'Y (A IL, t I !--'!Y1 <br /> M !.24 tA'..i 4 q <br /> er'iai Design Ctty Required Batched Var " Var mois'Nre Actual Wat Tot.Wdt Trim <br /> :n1 <br /> 2175"00 16 C I2W.60 I b 21320.00 i b 22.40 0.i i x 8,8011 1+1 2€26,64 q! 245.89 <br /> SENT 768.0@ Ib <br /> 87 00 ib 8700.go ib --12.r -0.14% <br /> rrF 611.00 gtil 2'4'iY gal c?4.00 gz.i. -.58 -0.25. 234.N gl c234.IN "11.KI <br /> Null Aatche : 2 Mamial 14:06:38 <br /> A Tatai: 3197" lh Design 0.51: Water/Cesant tt,423.:, G Gerin 540.0 gi Aetlwt 49tt.b g1To Add. 77.4 gl <br /> :gyp: :1. Af}rt; # _kdjctst Watrr: 0.0 gl. Luad Trza mater: X1.0 C�D <br /> v' y j,,, -.,y <br /> 80UNIVERSAL Rev 4/12 <br />