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Plant: Begin Loading: To Job: Arrive Job: Start Unload: Finish Unload: Leave Job: Return Plant:
Customer Cade: Customer Name: Customer Job Number: Order Code/Date: -
j''Projec't Code Pioject Name: T C
t`G Project P.O.Number: 1'Order P.O.Numher.`" C.* -•
Ticket Date: Delivery Address: Map Page;-- Map/Row/Column:
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Delivlary'Ihstrllctibnst k " ' l "`` 9 T A I a C �- Dispatcher:
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( I R,6i Ticket Numtie •=
Due On Job: Slump: Truck Number: Driver Number: Driver Name: End Use:
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LOAD CUMULATIVE ORDERED MATERIAL CODEPRODUCTION DESCRIPTION UOM UNIT PRICE; AMOUNT
QUANTITY QUANTITY QUANTITY f
l [?, i_?:_' 1t:. _ _ 1.(J 00 151-- •r ! 'r i =f_i00 It.l=�]!F .�, _li [_', ! 1 � f� J
I,,;{t .�,..�17 ,1S SURCHARGE _I.tom.,r ..)f_1 a.r._a
_}t-' P,:r.1 :-. 4bl T.l'�rl��`.ti�� EN r{-d1..., f_.�111i?�';i =
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=iM101.jIN-1'7 1,7708 T-i C�1 ET Pal:."# T `I`1—i IE NG T ti:?PY C'.-11=,1
Cash ',Check#/Aulh Code: Signature of Driver Receiving Cash: Cash Received: Total COD Order Amount to Collect
Without Standby Charges:
Check
Charge �,� ,
Comments:
WATER ADDED.,F+� `� GAL YARDS IN DRUM:
WHEN ADDED.
SIGNATURE
1 CURB LIN, CROSSED AT OWNER'S/AGENT'S REQUEST:
C t�1`�C'RI-�� D 1 S t���1:5]" i.., i'-r_.L /rI �:::•`` ^A _� ter, - ::.�
f-t I IAL FULL 1.._ YARDS
; /� SIGNATURE
_..� -•--•— ❑LOAD WAS TESTED BY:
Notice: Our drivers will make every effort to place materials where the customer designates,but thel SPECIAL TERMS: Any water added is at customers own risk.,If water is added'on job;concrete strength
Company assumes no responsibility for damages inside curb or property line. Customer agrees•to the is no longer guaranteed. WARNING: Product may cause skin,and/or eye irritation.•CAUTION: Material
terms of sale and delivery and accepts concrete as is. Due to important factors which are out of our may be hazardous to your safety and health. Please refer to the backside of:this ticket for important
control after delivery,this Company will not accept any responsibility for the finished results. No credit for safety handling information,and to the material safety data sheets for additional'ihfor iation.
returned concrete. Buyers exceptions and claims shall be deemed waived unless made to us in writing AUTHORIZED SIGNATURE:
wthin one business day after the receipt of materials. O;
68UNIVERSAL P,R,E Y T R1'.
INVOICE
-This Delivery Ticket incorporates herein by reference Buyer's previously executed Credit Application, if any, Seller's Standard
Terms and Conditions, Seller's Quotation, if any, and Seller's Order Confinnation(including limitations of warranties), as if fully
set forth on this Delivery Ticket("Agreement"). Seller will provide the Standard Terms and Conditions upon request. Buyer agrees
that, unless otherwise noted on the front hereof, all.quantities and items were delivered as indicated and further expressly agrees to
pay in accordance with the Agreement.
AGGREGATE / CEMENT / CONCRETE PRODUCTS / FLY ASH
Aggregate products are naturally occurring,materials including limestone,dolomite,granite,volcanic rock,sand,gravel,and other
siliceous'.mater-ials.`Cement products%inclu'de Portland cement, masonry, pozzolan (Type IP), roof tile, and stucco. Concrete
products`include Portland cement and aggreaat6producis including limestone, dolomite, granite,volcanic rock, sand, gravel, and
other siliceous materials. These products, including fly ash, may contain more than 0.025% crystalline silica.
Hazards: Freshly mixed wet cement and/or fly ash can cause eye irritation, skin and eye burns and allergic skin reactions.
Dry concrete and aggregate dust may cause irritation to eyes, skin, and/or respiratory tract.Dust from handling,
- crushing, grinding, cutting and/or drilling may contain silica, which may cause silicosis and cancer if inhaled.
If ingested, keep warn, at rest, and drink large amounts of water.Fly Ash may contain,trace amounts of ammo-
nia, Moisture can cause the ammonia to be released. Inhalation of ammonia can cause coughing and.irritation
or burns of the nose,,throat-arid lungs. See physician. Health risk depends on duration and level of exposure.
Safety: Avoid,contact with eyes and prolonged contact with skin.Wear gloves,eye protection, and appropriate prgtecti.ve
clothing. Wash hands thoroughly with mild soap and water after handling. Avoid breathing dust. If exposed to
dust above recommended limits (see MSDS), wear suitable NIOSH-approved respiratory protection.
First Aid: In case of eye contact,immediately flush eyes with flowing water for 1.5 minutes.If dust is inhaled,move to fresh
air.If wet cement contacts skin,rinse thoroughly with water. Get proper medical attention if irritation persists.
CEMEX,Memorial Hermann Tower
929 Gessner, Suite 1900
V7 combined Houston,Texas 77024
02/12 For more infonnation please visit www.cemexusa.coin.
,Este-ticket-de entrega iricluye;dmo referencia al comprador (ya previamente ejecutada en su aplicacion de cr6dito); cualquier
termino -- _ ar, condiciones de—vendedor,-dor, del vendedor y orden de coiifi.rmaci6n del vendedot (con limitations y
(yarantias),Como acuerdo total'del ticket de entrega("Contrato").El-vendedofproyeey.a_los tei7ninos estandares y condiciones detal-
lados en caso de asf ser requeridos.Con este documento,el comprador acepta los ihismos ya antes mencioriad6s y que las-cantidades
y materiales fueron entregados como se expresa en el inismo.Acepta pagar el monto de acuerdo al contrato; al menos que se identi-
fique con una nota al frente de este documento.
AGREGADOS / CEMENTO / PRODUCTOS DE CONCRETO / CENIZAS VOLANTES
Los productos de agregados son materiales naturales como piedra caliza, dolomi.ta, granito, coca volcdni.ca, arena, grava y otros
materiales silicios. Los productos de cemento incluyen Cemento de tipo Portland, de albaf ile.rfa, pozzolan (tipo IP), azulejo de
azotea y estuco. Los productos de concreto incluyen cemento Portland y productos de agregados como piedra caliza, dolomita,
granito,coca volcdnica, arena, grava, y otros materiales silicios. Estos productos incluyen cenizas volantes (fly ash) la cual puede
contener mas de 0.025% de silicio cristalino.
1
Peligros: Mezcla de cemento fresco y/o cenizas volantes pueden causar irritaci6n en los ojos, quemaduras en piel y ojos, y
reacciones al6rgicas•en la pint. Concreto Seco y polvo de agregad6,pueden causar irritaci6n en los ojos,,--piel py/o en
la zona respiratoria. Polvo del manejo en el trituramiento,pulido, torte y/o perforation puede contener materiales-
silicos, los cuales pueden causar silicosis pulmonar y cancer si son inhalados. En caso de ser ingeridos,mantenefse
en temperatura calida,reposar y tomar grandes cant.idades de agua."'Las cenizas volantes pueden contener amoniaco.
Seguridad: La humedad puede causar la liberation del amoniaco. La inhalation del amoniaco puede causar toser, irritaci6n o
quemaduras en la nariz, garganta y pulmones.Acudir inmediatamente al medico. El riesgo en la salud depende en
la duration y el nivel de la exposici6n.
Seguridad: Evite el contacto con ojos y contacto prolongado con la piel. Use guantes,protection en los ojos y ropa
Primeros adecuada para protecci6n.Lavese las manos con jabon suave y agua despu6s del manejo de materiales.Evite inhalar
auxilios: polvos. Si se expone a polvos mas de.los limites recomendados, use proteccion respiratoria.
Primeros auxilios: En caso de contacto en los ojos, inmediatamente fluya agua en la parte afectada por 15 minutos.
Si se inhala polvo, exp6ngase a aire fresco. Si el cemento fresco-ti.ene contacto con sus ojos, ldvelos a fondo con
agua.Acuda a atedei6n medica inmediatamente si la 'irritacion continua.
CEWX, Memorial Hernatin Tower
929 Gessner, Suite-1900
ombna_do Houston,Texas 77024
Para mds information visita www.cemexusa.com.
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CEmcx ,
Plant: Begin Loading: To Job: Arrive Job: Start Unload: > ur�Fi/nir/sh Unrl'ad:'- `-Leave Job ,'}�Retum,Plant:, '
r
Customer Code: Customer Name: Customer Job Number: Order Code/Date:
['iProjecf Code:; ,= tProje`Na rjea ( f'�`r•,f I',# Project P.O.Number: Ll.Order P.O.Number,:,,J c, r
_ �
Ticket Date: Delivery Address: 1/`" E/ 1 (,' f t -Map Page:'i.7 Map/Row/Column:
+-' °.t •.+ %,{':^1 L:�`-:�c.•_r•�-t_�1.d '"#' ("�I s 'j' •i,'^'t j i_��C t�.
Delive`rylnstrucftons: -- I
SC F i.f t:,;T
Due On Job: Slump: Truck Number: Driver Number: Driver Name: End Use:
t. _. •�le _ � .! •_ ..•L_,._^�J 1'� 1.•_ .���:..fi ,'d,1.F4a�fa_ !''ii.Jl li\.5.�...+ .Jlvr,�.!•."J.��n v!�AJ
LOADCUMULATIVE ORDERED MATERIAL CODE PRODUCTION DESCRIPTION UOM UNIT PRICE AMOUNT
QUANTITY i,QUANTITY QUANTITY
-,"3 .a .f. 75 L_f'_•r
,
.t ,,�.`-, ,.r is i Ct• .�.'! t w t 7�_.i;-tir"v`r;!','�-�ly _ 12
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C S ,l r 1
aI L.
.. A:. r
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J! �..J . l ._ �j� r.Y J f �6 1. P ��!" 11
Cas7h1t heck#/Auth Code: Signature of Driver Receiving Cash: Cash Received: Total COD Order Amount to Collect
ithout Standby ChargeChe'ChaComme �•; ,- rf'
WATER ADDED: GAL YARDS IN DRUM:
,;"• �" WHEN ADDED.
tj'.• ; SIGNATURE
rr.•..t R1 :., ,_. }!. ` �tw,.�,.�. .,_ c` CURB LIf�E CROSSED AT REQUEST-,ER'S/AGENT'S REQUEST:
i _;•'�i_.;, -__ _,__ F I_1.1_ �..4_!,s'""I�� '_!`.... yf. ;;^)c
SIGNATURE
El LOAD WAS TESTED BY: ° A
IJofice: Our'd&ers'will make every effort to place materials where the customer designates;but the. SPECIAL TERMS: Any water added is at customers own risk. If water is added on job,concrete s'tr'ength
GtompAny assumes no responsibility for damages inside curb or property line. Customer agrees to the is no longer guaranteed. WARNING: Prddrict.may cause skin and/or eye irritation. CAUTION: Material
terms of sale and delivery and accepts concrete as is. Due to important factors which are out of our may be hazardous to your safety and health. Please refer to the backside of this ticket for important
control after delivery,this Company will not accept any responsibility for the finished results. No credit for safety handling information,and to the material safety data sheets for additional information:
returned/concrete. Buyers exceptions and claims shall be deemed waived unless made to us in writing AUTHORIZED SIGNATURE:.
within one business day aftbr the receipt of materials. 0 4 '
.4: rtt_i( 11 'fit �; i !!iic L `",�1• 'hlt:-i ! °,[ 1R, I i_tiY• S{lJjrrja °
68UNIVERSAL INVOICE
1'`.
11us Delivery Ticket incorporates nerem ey reterence buyers previousiy
Terms and Conditions, Seller's Quotation, if any, and Seller's Order Confinnatl.U:
set forth on this Delivery Ticket("A reement" Seller will rovide the Standard Term,,:,
that, unless otherwise noted on the front hereof, all quantities and items were delivered
a in accordance with the Agreement.
pay b
AGGREGATE / CEMENT / CONCRETE PRODUCTS / N1L__,:::
Aggregate products are naturally occurring materials>hcludin 1'mestone dolomite r�rrite volcanic rock,sand;`
gg n p Y b g �. ,t;
siliceous,materials. 'Coment producis include Portland,cement, masonry, pozzolan (Type IP), roof tile, and stucco: Conc`ret-- "
!.prodricts`include',Portland cement and-aggregate prodilcts including limestone, dolomite, granite,volcanic rock, sand, gravel, and
other siliceous materials. These products, including fly ash, inay contain more than 0.025% crystalline silica.
CAUTION!
..e
Hazards: Freshly mixed wetcement�and/or fly ash can cause eye irritation, skin and eye burns and allergic skin reactions.
Dry concrete and aggregate dust may cause irritation to eyes, skin, and/or respiratory tract.(Dust from handling,
crushing, grinding, cutting and/or drilling may contain silica, which may cause silicosis'and cancer if inhaled.
If ingested, keep warm, at rest, and drink large amounts of water. Fly Ash may contain trace amounts of ammo-
nia. Moisture can cause the ammonia to.-be released. Inhalation of ammonia can cause coughing and irritation
or burns of the nose, throat and lungs. See physician. Health risk depends on duration and level of exposure.
Safety:. Avoid contact with eyes and prolonged contact with skin. Wear gloves,eye protection,and appropriate protective
clothing. Wash hands thoroughly witli mild soap and water after handling. Avoid breathing dust. If exposed to
dust above recommended limits (see MSDS), wear suitable NIOSH-approved respiratory protection.
First Aid: In case of eye contact,immediately flusIf byes with flowing water for 15 minutes. If ddstis inhaled,move"to frdsli
air.If wet cement contacts skin, rinse thoroughly with water. Get proper medical attention if irritation persists.
` CEMEX, Memorial Hennann Tower
929 Gessner, Suite 1900
V7 combined- Houston,Texas 77024-
02/12
702402/12 For more information please visit www.cemexusa.com.
Este ticket de entrega incluye tomo referencia al. comprador (ya previamente ejecutada en su aplicacion de.credito); cualquier
termino estindar, condiciones'del vendedor, propuestas dei.vendedor y orden de confirmation del vendedor (ion limitaciones y
garantfas),tomo acuerdo total del ticket de entrega("Contrato").El vendedor proveera los terminbs estaridares y;condiciones detal-
lados en caso de asf ser requeridos.Con esie documento,el coniprador acepta los mismos ya antes mencionados y que las cantidades
y materiales fueron entregados coma se expresa en el mismo.Acepta pagar el monto de acuerdo al contrato; al menos que se identi-
fique con una nota al frente de este documento.
AGREGADOS / CEMENTO / PRODUCTOS DE CONCRETO /-CENIZAS VOLANTES
Los productos de agregados son materiales naturales como piedra caliza, dolomita, granito, rota volcanica, arena, grava y otros
materiales silicios. Los productos de cemento incluyen Cemento de tipo Portland, de albanilerfa, pozzolan (tipo 1P), azulejo de
azotea y estuco. Los productos de concreto incluyen cemento Portland y productos de agregados como piedra caliza, dolomita,
granito,coca volcanica, arena,grava, y otros materiales silicios. .Estos productos incluyen cenizas volantes (fly ash) ]a cual puede
contener mas de 0.025% de silicio cristalino.
1CUIDADO!
Peligros: Mezela de cemento fresco y/o cenizas volantes pueden causar irritacion en los ojos, quemaduras en piel y ojos,y
reacciones alergicas en la piel. Concreto seco y polvo de agregados,pueden causar irritacion en los ojos,piel y/o en
la zona respiratoria. Pelvo del manejo en el trituramiento, pulido, conte y/o perforation puede contener materiales
silicos, los cuales pueden causar silicosis pulmonar y cancer si son inhalados. En caso de ser ingeridos,m mtenerse
en temperatura cal.ida,reposar y tomar grandes cantidades de aqua.Las cenizas volantes pueden contener viiornaco.
Seguridad•- L-A humedadpuede causar la liberation del amoniaco. La inhalation del amoniaco puede causar'toser, irritacion o
• quemaduras en la nariz, garganta y pulmones.Acudir inmediatamente it medico. El ries ci en la salud depende era
la duration y el nivel de.la exposition.
Seguridad: Evite el contacto con ojos y contacto prolongado con la.piel. Use guantes,proteccion en los ojos y ropa
Primeros adecuada para proteccion.Ldvese las manos con jabon suave y agua despues del manejo de materiales.Evite.inhalar
auxilios: pelves. Si se expone a polvos mas de los limites recomendados,use proteccion respiratoria.
Primeros auxilios: En caso de contacto en los ojos,inmediatamente fluya agua en la parte afectada por 1.5 minutos.
Si se inhala polvo, expongase a-wire fresco. Si el cemento fresco tiene contacto con sus ojos, .lavelos a fondo,con
agua.Acuda a�atencion incdica inmediatamente si]a irritacion continua.
CEMEX, Memorial Hermann Tower
929-.Gessner, Suite .1900
V7 combinado Houston,Texas 77024
02/12 Para mas information visita www.cemextisa.com.