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1142 Water -Tower Road, Lake Park FL 33403 ii
Office. 1-877-484-9994 /- Fax: 561-844-7102 i� .
15,
South East Florida Division'Dispatch: 561-844-9994 / Central Florida Division Dispatch: 407-339-5311 _ 1
Concrete Tested ❑ Yes No LOT #
Water Added at Customer's
Cylinders Taken - ❑ Yes No
Request
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Comments '' ��
gals, to full load
gals. to 2/3 load
( f gals. to 1/3 load
Customers Rep - Water Added
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- NOT RESPONSIBLE FOR WARNING IRRITATION TO THE SKIN AND EYES
VARIATION IN COLOR OR Cement polymer or freshly mixed' concrete may cause skin injury. Avoid contact with i ADDITIONAL WATER ADDED TO THIS
SURFACE DISCOLORATION skin and wash exposed skin areas promptly with water. If any cement powder or CONCRETE WILL REDUCE ITS STRENGTH
mixture gets into eyes, rinse immediately and repeatedly with water and get prompt AND DURABILITY: ANY WATER ADDED IS.
BATCH TIME ;.;. .: medical attention. Keep children away from cement powder and all freshly mixed
AT CUSTOMER'S OWN RISK.
cement products. �
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SIGNATURE OR RECEIPT -
CONCRETE AND ACKNOWLEDGEMENT OF HAZARD WARNING i
asc met oncrete ompany w� ' no ass 1 ity or any properly amage or any
_ equipment damage'for any%d}eliveries beyond the curb,,line. I I SUB -TOTAL
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T11 AX 1 f 9 1 AUTHORIZED.BY !
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SHIPMENT SUBJECT TO COND7IONS ON.REVERSE SIDE. I TOTAL.