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Plant:
Begin Loading:
--,,To Job:
Arrive Job:
Start Unload:
Finish Unload:
Leave Job:
Return Plant:
Customer Code: Customer Name:
Project Code: Project Name:
Ticket Date: Delivery Address:
Delivery 'Instruc"tib"ns:
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LOAD CUMULATIVE ORDERED 'PRODUCTION DESCRIPTION
QUANTITY QUANTITY QUANTITY MATERIAL CODE U0M UNIT PRICE AMOUNT.
Customer Job Number: Order Code / Date:
Project P.O. Number., Order P.O. Number:
Map 'Page: Y Map/Row/Column:
Dispatcher:
Ticket Number'.
Due On Job:
Slump:
Truck Number:
Driver Number:
Driver Name:
End Use:
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Cash Check # / Auth Code: Signature of Driver Receiving
Check
Charge
Comments:
WATER AD
CURB
Cash Received
Total COD Order Amount to Collect
Without Standby Charges:
GAL YARDS IN DRUM:
'WHEN ADDED.
SIGNATURE
kT OWNER'S/AGENT'S REQUEST:
UNCMETE D! FE. E� k
P.ARTRAL. FULL LOAD YARDS 7 , SIGNATURE
LI LOAD W�3 r7 EST BY,,y
I I
Notice: Our drivers will make every effort to place materials where the customer designates, the I SPECIAL TERMS ny wateradde--dis at customers own ris&�4ater is added on job, concrete strength
agrees
to 1. no
Company assumes no responsibility for damages inside curb or property line. Customer a thelonger guaranteed. WARNING: Product may cause s , Idq and/or eye irritation. CAUTION: Material
terms of sale and delivery and accepts concrete as is. Due. to important factors which are out o� our may be hazardous to your safety and healtff.' Please refeYto the backside of this ticket for important
0 t r � s n
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 w in writing AUTHORIZED SIGNATURE: 19
within one business day after the receipt of materials.
t V i K K
'68UNIVERSAL
INVOICE
This Delivery Ticket incorporarANiierein by reference Buyer's previously e uted Credit Application, if any, Seller's Standard
Terms and Conditions, Seller's .. ,tation, if any, and Seller's Order CIonfirn��n (i.ncluding limitations of warrantit.., s if 1 ull.y
set forth on this Delivery Ticket ( Agreement"). Seller will provide th ;Standa`rd Terms and Conditions upon request. buyer agrees
that, unless otherwise noted on the front hereof, all quantities and itenjs were delivered as indicated andfurth.e.r expressly agrees to
pay in accordance with the Agreement.
AGGREGATE /EMENT / CONCRETE PRODUCTS / FLY ASH
Aggregate products arc naturally occurring materials including limestone, dolomite, granite, volcanic rock, sand, gravel, and other
siliceous materials. Cement products include Portland cement, masonry, pozzolan (Type IP), roof tile, and stucco. Concrete
products include Portland cement and aggregate products .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,
cnishing, 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 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 15 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 information please visit www.cemexuse,com.
Este ticket de entrega incluye Como referencia at comprador (ya previamente ejecutada en su aplicaci6n de_ cr6dito): cualquier
t6rmino estdndar, condiciones del vendedor, propuestas del vendedor y- orden de confirmaci6n del vendedor (con limitaciones y
-garantias), como acuerdo total del ticket de entrega ("Contrat6"). El vendedor proveera los t6rminos estarrdares y condiciones detal-
lados en caso de asf ser requeridos. Con este documento, el comprador acepta los mismos ya antes mencionados y que las cantidades
y materiales fueron entregados como so expresa en el mismo. Acepta pagar el monto de acuerdo at contrato; at menos que se identi.-
fique con una nota at frente de este documento.
AGREGADOS / CEMENTO / PRODUCTOS DE CONCRETO / CENIZAS VOLANTES
Los productos do agregados son materiales naturales como piedra caliza, dolomita, granito, rocs volcanica, arena, grava y otros
materiales silicios. Los productos de cemento incluyen Cemento de tipo Portland, de albaflilerfa, pozzolan (tipo IP), azulejo de
azotea y estuco. Los productos de concreto incluyen cemento Portland y productos de agregados corn.o piedra caliza, dol.om.ita,
granito, roca volcanica, arena, grava, y otros materiales silicios. Estos productos incluyen cenizas volantes (fly ash) la cual puede
contener mas de 0.025% de silicio cristalino.
Peligros: Mezela de cemento fresco y/o cenizas volantes pueden causar irritaci6n en los Ojos, quemaduras en piel y ojos, y
reacciones al6rgicas en la pie]. Concreto seco y polvo de agregados, pueden.causar irritaci6n en los ojos, piel y/o en
Id zona respiratorria. Polvo del manejo en el trituramiento, pulid.o, come y/o perforaci6n puede contener materiales
silicos, los cuales pueden causar silicosis pulmonar y cancer si son inhalados. En caso de ser ingeridos, mantenerse
en temperature calida, reposar y tomar grandes cantidad_ es de agua. Las cenizas volantes pueden contener amoniaco.
Seguridad: La humedad puede causar la liberaci6n del amoniaco. La inhalaci6n del amoniaco puede causar toser, irritaci6n o
quemaduras en la nariz, garganta y pu.lmones. Acudir inmediatamente at medico. El riesgo on la salud depende en
la duraci6n y el nivel de la exposici6n.
Seguridad: Evite el contacto con ojos y contacto prolongado con la piel. Use guantes, protecci6n en los ojos y ropa
Primeros adecuada para protecci6n. Ldvese ]as manos conab6n suave y agua despu6s del manejo de materiales. Evite inhalar
auxilios: polvos. Si se expone a polvos mas de los limites recomendados, use protecci6n respiratoria.
P.rimeros aux.ilios: En caso de contacto en los ojos, inmediatamente fluya agua en la parte afectada por 1.5 minutos.
Si se inhala polvo, exp6ngase a aire fresco. Si el cemento fresco tiene contacto con sus ojos, lavelos a fondo con
agua. Acuda a atenci6n m6dica inmediatamente si la irritaci6n contin6a.
CEMEX, Memorial Hermann Toyver
929 Gessner, Suite 1900
V7 combinado Houston, Texas 77024
02/12 Para mas information visita www.cemexusa.com.
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Plant:
Begin Loading:
To Job:
,Arrive Job:
Start Unload:
Finish Unload:
Leave Job:
Return Plant:
i
Customer Code:
Customer:Name:
1;
Project Code:
Project Name;',
y
j •
Ticket Date:
Delivery Address:
f: Deliveryinstructions:
Customer Job Number:
Order Code / Date:
Project P.O. Number:
Order P.O. Number:
Map Page: Map/Row/Column:
Dispatcher:
Ticket Number:
,iiil"r
Due On Job:
Slump:
Truck Number.,-,
Driver Number:
Driver Name;
End Use:
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LOAD CUMULATIVE ORDERED QUANTITQUANTITY QUANTITY MATERIAL CODE PRODUCTION DESCRIPTION UOM UNIT PRICE AMOUNT
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Cash Check # /Auth Code:. Signature of Driver Receiving Cash: 7Cish Received; a ', Total COD Order Amount to Collect
` - Without Standby Charges:
Check �` _ -• , .
Charge
Comments: r ,
WATER AD Eb: 4- i GAL YARDS IN DRUM:
WHEN ADDED.
SIGNATURE
i, CURB LINE•CRROSSED/ATDWNER'S/AGENT'S REQUEST:
SIGNATURE
WAED BY0 LOAD TESTNotice: Our drivers will make every effort to place materials where the customer designates, "but the' SPECIAL TERMS;,.Ann)`water-added is at customers own risV If -water is added on job, concrete strength
Company assumes no responsibility for damages inside curb or property"lirie: Customer agreesito 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 odt of our may be hazardous to your safety and health. Please refe 'to the backside of this ticket for important
control after delivery, this Company will not accept any responsibility for the finished results. No dedil 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:, t
within one business day after the receipt of materials.
63UNIVERSAL CUSTOMER
t
This Delivery Ticket incorpora lerem by reference Buyer's previously ( ited Credit Application, if any, Seller's Standard
Terms and Conditions, Seller's )tation, if any, and Seller's Order Confiri )n (including limitations of warranti< 0as-if :fully
set forth on this Delivery Ticket k• AAgreement"). 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 materials. Cement products include Portland cement, masonry, pozzolan (Type IP), roof tile, and stucco. Concrete
products .include Portland cement and aggregate products including including fly
dolomite, granite, volcanic rock, sand, gravel, and
other siliceous materials. These products, includingfly 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 warm, at rest, and drink large amounts of water. Fly Ash may contain trace amounts of arnmo-
nia. Moisture can cause the arnmonia to be releasedt- Inhalation of ammonia can cause coughing and irritation
or burns of thenose, 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 with mild soap and, water after handling. Avoid breathing dust. If exposed to
dust above reeftmended limits (see MSDS), wear suitable NIOSH-approved respiratoiy�protection.
First Aid: .In case of eye contact, immediately flush eyes with flowing water for 15 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 information please visit www.cemexusa.com.
Este ticket de entrega incluye corno referencia al comprador. (ya prcviamente ejecutada en su aplicaci6n de cr6dito); cualquier,
t6rmino est6ndar, condiciones del vendedor, propuestas del vendedor y, orden de confirmaci6n del vendedor (con limitaciones y
garantfas), como acuerdo total del ticket de entrega ("Contrato" ). El vendedor proveera los t6rminos estandares y conditions detal-
lados en caso de asf ser requeridos. Con este docum.ento, el comprad6r acepta los mismos ya antes mencionad.os y quo las canti.dades
y materiales fueron entregados como se express en el mismo. Acepta pagar el monto de acuerdo al contaato; al menos quo so identi-
fique con una nota a] frente de este documento.
AGREGADOS / CEMENTO / PRODUCTOS DE CONCRETO / CENI7AS VOLANTES
Los productos de agregados son materiales naturales como piedra caliza, dolomita, granito, rota volcanica, arena, Brava y otros
materiales silicios. Los productos de cemento incluyen Cemento de tipo Portland, de albanilerfa, pozzolan (tipo IP), azulejo de
azotea y estuco. Los productos de concreto incluyen cemento Portland y productos de agregados como pi.edra caliza, dolomita,
granito, rota 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.
Peligros: Mezcla de cemento fresco y/o cenizas volantes pueden causar irritaci6n en los Ojos, quemaduras en piel y ojos, y
reactions al6rgicas e❑ la piel. Concreto seco y polvo de agregados, pueden causar irritaci6n_en los ojos, piel y/o en
la ZJDa respiratoria. Polvo del manojo en el trituramierito, pulido, carte y/o perforaci6n puede contener materiales
silicos, los cuales pueden causar silicosis pulmonar y cancer si son inhalados. En caso de ser'ingeridos, mantencrse
en temperature calida, reposar y tomar grandes cantidades de agua. Las cenizas volantes pueden contener amoniaco.
Seguridad: La hum.edad puede causar la liberation del am.oniaco. La inhal.aci6n del amnniaco puede causar toser, irritaci6n o
qu.emaduras on la nariz, garganta y palmones. Acudir .inmediatamente al. medico. El riesgo en la salud depends on
la duraci6n y el.nivel de la exposici6n.
Seguridad: Evite el contacto con ojos y contacto prolongado con .la piel. Use guantes, protecc.i6n en los ojos y ropa
Primeros adecuada para protecci6n. Lavese ]as manos con jab6n suave y agua despu6s del manejo de materiales. Evite inhalar
auxilios: polvos. Si se expone a polvos mas de los limites recomcndados, use protecci6n respiratoria.
Primeros auxilios: En caso de contacto en Jos ojos, inmediatamente fluya agua en la parte afectad.a por 1.5 minutes.
Si se inhala polvo, exp6ngase a aire fresco. Si el cemento fresco tiene contacto con sus ojos, Javelos a fondo con
agua. Acuda a atenci6n m6dica inrrrediatamente si la iriitaci& continda.
CEMEX, Memorial Hermann Tower
929 Gessnerr, Suite 1900 t-
V7 combinado Houston, Texas 77024
02/12 Para .m.as informacion visita ww(v.eemexusa tom.