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0 7 - 003637 ' <br /> (209) 838-1448 DELIVERY TICKET <br /> WEIGHMASTER CERTIFICATE AGENT COPY <br /> THIS IS TO CERTIFY that the following described commodity was weighed,measured,or counted <br /> PRODUCTS by a weighmaster,whose signature is on this certificate,who is a recognized authority of accuracy, <br /> as prescribed by Chapter 7(commencing with Section 12700)of Division 5 of the California <br /> oad, Escalon,CA 95320 Business and Professions Code,administered by the Division of Measurement Standards of the <br /> California Department of Food and Agriculture. <br /> OWNER/AGENT/CONSIGNEE <br /> ON JOB TIME MIX I.D.# CUBIC YARDS CUBIC YARDS ORDERED <br /> DATE LOADTIME LOAD CUBIC YARDS DELIVERED <br /> BATCH SLUMP TICKET NUMBER TRUCK#/DRIVER WEIGHMASTER: P&L CONCRETE PRODUCTS <br /> DEPUTY— -- <br /> This agreement requires compliance with the requirements Yes NO H2O ADD GALLONS TIME EST.YDS.IN TRK <br /> of the Public Labor Code and falls under AB219. 1„ <br /> My signature acknowledges that I agree to the property damage release,A6219,and all terms 2nd _ —and conditions of this entire delivery as stated on the reverse side. 31" — — <br /> PRINT NAME: SIGNATURE: Additional: <br /> DEPARTED PLANT ARRIVED JOB START UNLOADING ADDITIONAL CHARGES UNLOAD TIME <br /> PUMP WASH $ <br /> RETURNED TO PLANT LEFT JOB FINISH UNLOADING COLOR ADD $ TIME ALLOWED <br /> OTHER ❑ $ CARTAGE _ <br /> TOTAL ROUND TRIP TOTALAT JOB UNLOADING TIME DRIVER SIGNATURE: STANDBY TIME ADDITIONAL CHARGE - <br /> X GRAND TOTAL$ <br /> CODE DESCRIPTION UNIT PRICE EXTENDED PRICE <br /> GALLONS PLASTICIZER <br /> BATCH FORMULA <br /> FRP&L(REV.07/24) <br /> 7 - <br />