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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 of ZEMEX <br /> 426735- 8- 11 <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. e <br /> F <br /> r - <br /> Plant: Begin Loading: To Job: Arrive Job: ` Start Unloag;-._ 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 OU QUANTITY MATERIAL CODE PRODUCTION DESCRIPTION UOM UNIT PRICE AMOUNT <br /> ANTITY <br /> IZ►4'f l. ' +l?r 1.401_',--+9 l:,t•OUT C ',I dND <br /> 0. f7_IG'► 124?.;1?-J-_U1:;1__ ?LiRT1! G F_'f� <br /> x-AL Wr%0GET GL4T d'IlM 1-OOK, BE_Ff IRE OCC r.NG YOUFZ. -rR d, <br /> LOAD, i�H'C{5'RC;1 • I. <br /> �- / 1 <br /> r}r +.In CUI..lnt;er,: i � Iai�ri �tE L?- :�l�cfsc�3. 1= l_,C, <br /> _, <br /> L:!1'"E?V 1 O L4'� T Y"'+..!C,I i n yl.'},_r 5 5 9 .:_.-. _P c?.1'''t :[••=t I `- L!�. � �..L�;.-�L"I <br /> Water Added Curb Line Crossed At Owner's SUB TOTAL <br /> IN GALLONS: Agent's Request: (J <br /> AUTHORIZED SIGNATURE <br /> TAX <br /> /� Print Name: Date <br /> (XL_/ 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: - - - --- `t HI S 5 O 1 <br /> Y <br /> Trl!__k t?rive• Ti.(-k:: 9, eq oi-Ad Gompl.ete'd <br /> .l 00Fi,55 1•..l 44 53•J 8 c.l EJ..,/F.I 'J 121 <br /> al di 7 e <br /> M .+Ear i�a1L�• i( +.', +':. eft clt_ti.r~is c) E:atr:t�eea V r" `'! M0isturr-rc:j,t_!,�.1Wat Tort. Wd'J,<' rt <br /> N%IDN 2175 N It-,_ .... 16659 .15 .-1'b <br /> �El PAS- 8. 0 .lb 'VIE.111011 lb 67&0.09 1b -16.019 <br /> WATER r0,1�41 Val 156.14 gal 159.00 gal l4 -6.1� 156,419 it 158.AB., 1�r,98 g <br /> (coral . NQa Batches: 1 Makttal K!24: ' ' <br /> ,-oad Total: 2412 lb 6esign 0.517 4ter4mot 6.397 A DESi a AN.0 91. lictnal .321.2+t1 T,.F'_ qn." <br /> Slaap: 9.1?�rD irl # Ad),est Water. 0, 1 ./:Loadg Tri• Water:-14.9gi / 1 <br /> 80UNIVERSAL Rev4/12 <br />