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INVOICE WEIGHMASTER CERTIFICATE THIS IS TO CERTIFY that the following described commodity was weighed, measured, or counted by a weighmaster, whose signature is on this certificate, who is a recognized authority of accuracy, as prescribed by Chapter 7 (commencing with Section 12700) of Division 5 of the California Business and Professions /ZC E M G X Code, administered by the Division of Measurement Standards of the California Department of Food and Agriculture. NOTE: Excess water is detrimental to concrete quality. Increased water in concrete mix reduces strength and durability and increases shrinkage. Buyer accepts responsibility for water added on job site, which exceeds accepted water/cement ratio and workability specifications. Plant: Begin Loading: To Job: Arrive Job: Start Unload: Finish Unload: Leave Job: Return Plant: Total Amount for This Ticket Not Including Standby Charges: Cash Check # / Auth Code: Check Charge Signature of Driver Receiving Cash: Cash Received: Total COD Order Amount to Collect Without Standby Charges: customer code: L usiomer ivame: Project Code: Project Name: Ticket Date: Delivery Address: Delivery Instructions: Due On Job: Slump: LOAD CUMULATIVE .QUANTITY1 QUANTITY Load: Truck Number: ORDERED MATERIAL CODE QUANTITY Deputy Weighmaster: Order P.O. Number: Map Page: Ticket Number: Driver Number: Driver Name: End Use: PRODUCTION DESCRIPTION UOM UNIT PRICE AMOUNT Water Added Curb Line Crossed At Owner's -_\ SUB TOTAL IN GALLONS: Agent's Request: X AUTHORIZED SIGNATURE TAX Print Name: Date (X� Signature above signifies receipt and acceptance of the listed materials and acknowledge- TOTAL INITIALS INITIALS ment of and agreement to the CEMEX terms and conditions. BATCH DATA 80UNIVERSAL Rev 4/12