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CONCRETE COMPANY OF' FLORIDA, II�G:
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South East Florida Division Dispatch: 561-.8,44-9994i 1 Centra( Florida Division Dispatch: 407-339-'5311
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Concrete Tested ❑Yes No LOT #
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Cylinders Taken ❑ Yes No
Request
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gals. to full load
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"`'r ..r gals. to 2/3 load
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gals. to 1/3 load
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i Customer's Rep - Water Added
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NOT RESPONSIBLE FOR WARNING IRRITATION TO THE SKIN AND EYES
ADDITIONAL WATER ADDED TO THIS
VARIATION IN COLOR OR Cement polymer or freshly mixed concrete may cause skin injury. Avoid contact with .
skin and wash exposed skin areas promptly with water. If any cement powder or
CONCRETE WILL REDUCE ITS STRENGTH
SURFACE DISCOLORATION mixture gets into eyes, rinse immediately and repeatedly with water, andget prompt
medical attention. Keep children away from cement powder and all freshly mixed 1
� AND DURABILITY. ANY WATER ADDED IS
BATCH TIME . cement products.
AT CUSTOMER'S OWN RISK.
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TIME DUE
PRODUCT CODE'ii DESCRIPTION
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SIGNATURE OR RECEIPT:- CONCRETE AND ACKNOWLEDGEMENT OF HAZARD WARNING
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asc meyer ortcrete ompan'Will Hammy Tor any property uarnage or any �(
line.
( SUB -TOTAL
equip merif damage for any deliveries beyond the curb
TAX
AUTHORIZED BY
SHIPMENT SUBJECT TO`CONDITIONS ON REVERSE SIDE.
DOTAL
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