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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 _ _ 4 5 3 d <br /> signature is on this certificate,who is arecognized authority of f <br /> accuracy,as prescribed by Chapter 7(commencing with Section �" 4 <br /> 12700)of Division 5 of the California Business and Professions AIZC <br /> Code,administered by the Division of Measurement Standards <br /> of the Calilornia 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 <br /> QUANTITY QUAQUANTITY MATERIAL CODE PRODUCTION DESCRIPTION UOM UNIT PRICE AMOUNT <br /> NTITY <br /> 0 C71. 00 1.P47C.1 . IFUEL_ SPUF:l.::l- ARAE <br /> 0 0n 00 t2O'L--'749 Er,iVrRONNI 4-17AL. :CHAR E. <br /> GET ()U'Y (iND ....1'_lCW. F�Et ('1F'L:, f=alt l ' r.lt�= `r'Ol. R -FRI.ICt';ti.:¢ <br /> Water Added Curb Line Crossed At Owner's ' SUB TOTAL <br /> IN GALLONS: Agent's Request: �^J <br /> AUTHORIZED IGNATURE <br /> 1' TAX <br /> -- Print Name: Date <br /> 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: /� 2533152 C^J "�1 C 2 <br /> �.. `} l <br /> fipt,i-II Design F%r Req, iy`Ad 9etr:hed _ NjnicF ,,t'? ?i`r,' ?' wat 771 Wat w <br /> 75.01 1G 20119 3 16 0204N.00 iG 47 10 . 0 <br /> 968.00 i b 872'.00 i b .57 e.00 l b <br /> G0 00 gal 393.80, gal 393.1 gal -.9@ I) tC` <br /> Wis 9atches: C. 10214 - <br /> jTota.;.: 324►@ lb Design 0,g_7 Wate, %Ceae�t k.4? Design !94@,0 <br /> ap: 9.i�P+ in Adil!st !Date,: 0.0 gt Lrrad Trio �lAar,-5.r) gi C(D <br /> 80UNIVERSAL Rev 4/12 <br />