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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 A <br /> signature is on this certificate,who is a recognized authority of ZZC _M _X "r n 6 7 ' �f <br /> accuracy,as prescribed by Chapter 7(commencing with Section Its +0 5 3 <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 /> N - _ <br /> NOTE: <br /> 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 /> r <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: r-� p�rr� Customer Job Number: Order Code/Date: <br /> ' t..14ATER DRUL.L.._�NG I..,Q INC <br /> Project Code: Project Name: Deputy Weighmaster: Order P.O.Number: <br /> Ticket Date: Delivery Address: Map Page: <br /> : k_r­--y FAV 8: P. WC?Ol7W .IR.D Fw <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 /> �p C `' <br /> ��4_I ROLj I %:' l% I., 41,1D C;}'C) <br /> 1. 00 0. Q10 19:2470,1.*7 FIJF.=L. SUFIC>Jf_-1RG[. EA <br /> i . 00 0. 12112) 12FDi•_749 ENV7POVN1ENTOL cfs<i1`k E EF2 <br /> *-yPL,WCAYC)" GET OUT FIND L._0t7K 1:'F_FORE PACKII' O YOUR 'TRUCK** <br /> h�T;.1Ttr11.1t21 L..i.]t=tC� t:�i-lf,l-7[�) <br /> Cir-l.tm Col..tt-fter,� __...� -',.. ...._. C:oricT—ete Li =p'o_a1 Fec:' <br /> F^'r Es V l(7 1_I..ro T r�l.:t t:,k a f�' r-b i�:l F-t I T 1. L_ra-A J <br /> Water Added Curb Line Crossed At Owner's n SUB TOTAL <br /> IN GALLONS: Agent's Request: <br /> AUTHORIZED SIGNATURE <br /> TAX <br /> Print Name: Date <br /> Signature above signifies receipt and acceptance of the listed materials and acknowledge- TOTAL <br /> NITIALS INITIALS ment of and agreement to the CEMEX terms and conditions. /� ��++ <br /> BATCH DATA: 4257 l 35,80 <br /> f r'].4lal}t:"a:i.�,l ,e: '7 IiE'Cit_tAY'trC:i l lti:i: l ;•''13_71 �VIOiSil ': 'Al-Or-t1-t�.Wcst 'Ir�'; . i%.!,_:T <br /> NSC 2175.0 lb 4U,3.03 1 b 4708.00 1 h r. 36.97 0.79% 7.2101% A 37.81 g 1 37.91 <br /> CEMENT %-8.IN 1 b 1936.00 1b 1935.00 1 b -1.80 -0.05% <br /> WATER Go.00 ggal 54.49 gal 53.00 gal -1.40 -c.73% 53,0 g 53.00 -'4.IN 91. <br /> Actual Num Batches: 1 Manual 11:20:00 <br /> L:,ad Total, 7077 lb Design 0,517 Water/Cesent 0.352 A Design 120.0 gl actual 90.5 gi To Add; 29.2 gi <br /> Slurp: IN n # Adjust Water: 0,.0 gl r' load Tris Water:-t4,0g1 � CS <br /> 80UNIVERSAL Rev 4/12 <br />