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Plant: Begin loading: To Job: Arrive Job:. Start Unload: Finish Unload: Leave Job: Return Plant:
Customer Code: Customer Name:
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Project Code: Project Name: 3
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Ticket Date: Delivery Address:
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Delivery Instructions:
Customer Job Number: Order Code / Date:
Project P.O. Number: Order P.O. Number:
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Map Page: Map/Row/Column:
Dispatcher:
Ticket Number:
Due On Job:
Slump:
Truck Number:
Driver Number:
Driver Name:
End Use:
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WALL
LOAD
QUANTITY
CUMULATIVE
QUANTITY
ORDERED
QUANTITY
MATERIAL CODE
PRODUCTION DESCRIPTION
UOM
UNIT PRICE
AMOUNT
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Cash Check # /Auth Code:
Signature of Driver Receiving Cash:
Cash Received:
Total COD Order Amount to Collect
Check
Without Standby Charges:
Charge
Comments:
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WATER ADDED: Y / GAL YARDS IN DRUM:
WHEN ADDED.
SIGNATURE
CURB LINE CROSSED AT OWNERVAGENT'S REQUEST:
C(_NI'1i 111,17_ D I )P)O, )AL._ FEE \ \/� SIGNATURE
-.-�-_---__-- ❑ LOAD WAS TESTED BY:
Notice: Our drivers 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 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 information. 1
returned concrete. Buyers exceptions and claims shall be deemed waived unless made to us in writing AUTHORIZED SIGNATURE:
within one business day after the receipt of materials.
68UNIVERSAL , , �V t•,1 ^'i ' t
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This Delivery Ticket incorporates herein by .reference Buyer's previously executed Credit Appl"i.cation, if any, Seller's Standard
Terms and Conditions, Seller's Quotatic any, and Seller's Order Confirmation (.it ling limitations of warranties), as if fully
set forth on this Delivery Ticket ("Agree___-__:"). Seller will provide the Standard Tern d 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 Nv-ith 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 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 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, inunediately 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 atte tion if irritation persists.
CEMEX, Memorial Hermann Tower l
929 Gessner, Suite 1900
V7 combined Houston, Texas 77024
02/12 For more information please visit www.cemexusa.com. (✓ ii1,
Este ticket de entrega incluye Como referencia al comprador {,ya previamente ejecutada-en su aplicaci611,de cr6dito); cualquier
t6rmino estandar, 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 est{indares y condiciones detal-
lados en caso de asf ser requeridos. Con este doeumento, el compraclor acepta los mist -nos ya antes meneionaclos y que las cantidades
y materiales fueron entregados como se expresa en el nusmo. Acepta pagar el monto dg� acuerdo al co ral Enos q - se idmi-
fique con una nota al frente de este documento.
AGREGADOS / CEMENTO / PRODUCTOS DE CO_NCRETO / CEN. ( "Cliv
Los productos de agregados son materiales naturales como piedra caliza, dolomita, granito, roza.,vc ' r''va y olros
materiales silicios. Los productos de cemento incluyen Cemento de tipo Portland, de albanilerfa, z apti"'$?��,zulejo de
azotea y estuco..Los productos de concreto incluyen cemento Portland y productos de agregados como piedra caliza, dolomita,
granito, coca volednica, arena, grava, y otros materiales silicios. Estos productos incluyen cenizas volantes (fly ash) la cual puede
contener mds de 0.025% de silicio cristalino.
Peligros: Mezcla de cemento fresco y/o cenizas volantes pueden causar irritaci6n en los Ojos, quemaduras en pie] y ojos, y
reacciones al6rgicas en la peel. Concreto seco y po.lvo de-agregados, pueden causar irritaci6n. en Jos ojos, pie]. y/o en
la zona respiratoria. Polvo del manejo en el trituramiento, pulido, corte y/o pe.rforaci6n puede contener materiales
silicos, los cuales pueden causar silicosis pulmonar y cancer si son inhalados. En caso de ser ingeridos, mantenerse
en temperatura caliza, reposar y tomar grandes cantidades de agua. Las cenizas volantes pueden contener amoniaco.
Seguridad: La humedad puede causar la liberaci6n del amoniaco. La inhalaci6n del amoniaco puede causar toner, in.-itaci.6n o
quemaduras en la nariz, garganta y pulmones.°Acudir inmediatamente al medico. El riesgo en .la salud depende en
la duraci6n y el nivel de la exposici6n.
Seguridad: Evite el contacto con ojos y contacto prolongado con ]a piel. Use guantes, protecci6n en los ojos y ropa
Primeros adecuada para lnoteccidn. Ldvese las manos con jab6n suave y agua despu6s del manejo de materiales. Evite inhalar
auxilios: polvos.. Si se expone a polvos mds de los limites recomendados, use proteccj6n 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 tiene contacto con sus Ojos, lavelos a fondo con
agua. Acuda a atenci611.m6dica inmediatamente si la irritaci6n continua.
CEMEX. Memorial Hermann Tower
929 Gessner, Suite 1.900
V7 coinbinado Houston, Texas 77024
02/12 Para mas infonnaci6n vjsita www.cemexusa.com.