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Plant:
Begin Loading:
To Job:
Arrive Job:
Start Unload:
Finish Unload:
Leave Job:
Return Plant:
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Project Cade: _ Project Name
Ticket Date: Delivery,A..ddress;.
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Customer Job Number:
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Order,Crode / Date:
Order P.Q. Number.
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Ticket Number:
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LOAD CUMULATIVE ORDERED
QUANTITY QUANTITY QUANTITY MATERIAL'GODE PRODUCTION DESCRIPTION
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Cash Check # I Auth Code: Signature of Driver Receiving Cash: Cash
Check
Charge
Comments:
WATER ADDED:
a1
UOM UNIT PRICE AMOUNT
J RE . 2. Ate 7 o 15
d: Total COD Order Amount to Collect
Without Standby Charges:
GAL YARDS IN DRUM:
WHEN ADDED.
SIGNATURE
CURB LINE CROSSED AT OWNER'S/AGENT'S REQUEST:
PART T AL _ FULL LOPID '`t , PIRD 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,fo 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 11 foTationland 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 AUTHOR ET
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within one business day after the receipt of materials. O G�
68UNIVERSAL INVOICE
This Delivery Ticket incorporates herein by reference Buyer's previously executed r----'it Application, .if any, Seller's Standard
Terms and Conditions, Seller's Quotatio any, and Seller's Order Confirmation (in ing limitations of warranties), as if fully
set forth on this Delivery Ticket ("A(.1,reei__-__"). 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 1P), 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 0.02.5% 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, 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.cetne,xusa,qotn.
Este ticket de entrega incluye coma referencia al comprador (ya previamente ejecutada en sit aplicaci6n de eredito); cualquier
termino estandar, condiciones del vendedor, propuestas del vendedor y orden de confirmaci6n del vendedor (con limitaciones y
garant.fas), como acuerdo total del ticket de entrega ("Contrato"). El vendedor provee.rd los term.inos estandares y cond.iciones detal.-
lad.os en caso de asi ser.requeridos. Con este documento, el comprador acepta los mismos ya antes mencionados y que las canti.dades
y materiales fueron entregados como se expresa en el mismo. Acepta pagar el monto de acuerdo al contaato; al manos que se identi-
fique con una nota a] frente de este documento.
AGREGADOS / CEMENTO / PRODUCTOS DE CONCRETO / CENIZAS VOLANTES
Los productos de agregados son materiales naturales como piedra caliza, dolomita, granito, rocs volciinica, arena, Brava y otros
materiales silicios. Los productos de cemento incluyen Cemento de tipo Portland, de albaflilerfa, pozzolan (tiipo IP), azulejo de
azotea y estuco. Los productos de.concreto incluyen cemento Portland y productos de agregados como piedra caliza, dolom.ita,
granito, roca volcanica, arena, grava, y otros materiales silicios. Estos productos .incluyen cenizas volantes (fly ash) la coal puede
contener mks 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
reacciones alergicas en la piel. Concreto seco y polvo de agregados, pueden causar irritaci6n en los Ojos, piel y/o en
la zona respiratoria. Polvo del manejo en el trituramiento, pulido, corte 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 temperatura calida, 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 toser, irritaci6n o
quemaduras en ]a nariz, garganta y pulmones. Acudir inmediatamente al medico. El riesgo en la salud depende en
la duraci6n y el n vel de la exposiei6n.
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 con jab6n suave y agua despues del manejo de materiales. Evite inhalar
auxilios: polvos. Si se expone a polvos mas de los limites recomendados, use protecci6n respiratoria.
Primeros auxilios: En caso de contacto en los ojos, in.mediatamente fluya agua en la parte afectada por 1.5 minutos.
Si se inhala polvo, exp6ngase a wire fresco. Si el cemento fresco tiene contacto con sus ojos, lavelos a fondo con
agua. Acuda a atenci6n medica inmediatamente si la irritaci6n contin6a.
CEMEX, Memorial Hermann Tower
929 Gessner, Suite 1900
V7 combinado Houston, Texas 77024
'02/12 Para mas informaci6n visita www.ceinexusa.corn.
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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:
Ticket Date:,l Delive '
Delivery Instructions:
Customer Job Number: Order Code / Date:
Project P.O. Number. Order P.O. Number.
Map Page: Map/Row/Column:
Dispatcher:
Ticket Number:
Kc- 15r i
L 13
Due On Job:
Slump:
Truck Number:
Driver Number:
Driver Name:
End Use:
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LOAD
CUMULATIVE I
ORDERED
MATERIAL CODE
PRODUCTION DESCRIPTION
UOM
UNIT PRICE
AMOUNT
QUANTITY
QUANTITY
QUANTITY
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DEC s1 Am, 3: 16
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Cash Check # / Auth Code: Signature of Driver Receiving Cash: Cash Received: Total COD Order Amount to Collect
Without Standby Charges:
Check
Charge
Comments
WATER ADDED: GAL YARDS IN DRUM:
WHEN ADDED.
SIGNATURE
4 •y
CURB LINE CROSSED AT OWNER'S/AGENT'S REQUEST:
j_,t�t`� �. rPE � E a? �. f �r °F._I;: AL f"EE i ° SIGNATURE
-••---•--PARCTA---.••-•-..-,FIJI L
r •••-----•-•- ❑;LOAD WAS TESTED BY:
Notice: Our drivers will make every effort to place materials whefe 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/o�EyeArritation. CAUTION: Material
terms of sale and delivery and accepts concrete as is. Due to important factors which are out of our may be hazardrogs-to-your-safety and health. Please refer to the'backsidelof this ticket for important
control after delivery, this Company will not accept any responsibility for the finished results. No credit for safety hwolin-g'information, and the material safety data sheets for additional
returned concrete. Buyers exceptions and claims shall be deemed waived unless made to us in writing AUTHORIZED SIGNATUR
within one business day after the receipt of materials. X!
68UNIVERSAL f==
;� :t•,I itY:lr t- , 1. s rt z?' .,, �..�! INVOICE _sy NUM-. El
This Delivery Ticket incorporates herein by reference Buyer's previously executed -,edit Application, if any, Seller's Standard
Terms and Conditions, Seller's Quotati if any, and Seller's Order Confirmation ( zding limitations of warranties), as if fully
set forth on this Delivery Ticket ("Agre--rit"). 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 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, 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 comp referencia al cornprador (ya previamente ejecutada en su aplicacion de credito); cualquier
termino estdndar, condiciones del vendedor, propuestas del vendedor y orden de confirmacion del vendedor (con limitaciones y
garantfas), como acuerdo total del ticket de entrega ("Contrato"). El vendedor proveerd los t6rminos estdndares 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 se expresa en el mismo. Acepta pagar el monto de acuerdo al contaato; 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, roca volcdnica, arena, grava 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 piedra caliza, dolomita,
granito, roca volcdnica, 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: 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. Conereto seco y polvo de agregados, pueden causar irritacion en los ojos, piel y/o en
la zona respiratoria. Polvo del manejo en el trituramiento, pulido, corte y/o perforacion puede contener materiales
silicos, los cuales pueden causar silicosis pulmonar y cancer si son inhalados. En caso de ser ingeridos, mantenerse
en temperatura cdlida, reposar y tomar grandes cantidades de agua. Las cenizas volantes pueden contener amoniaco.
Seguridad• La humedad puede causar .la liberacion del amoniaco. La inhal.acion del amoniaco puede causar toser, irritacion o
quemaduras en la nariz, garganta y pulmones. Acudir inmediatamente al medico. El riesgo en la salud depende en
la duracion y el nivel de la exposicion.
Seguridad: Evite el contacto con ojos y contacto prolongado con la pie]. Use guantes, proteccion en los ojos y ropa
Primeros adecuadapara proteccion. Lavese ]as manos con jabon suave y agua despues del manejo de materiales. Evite inhalar
auxilios: polvos. Si se expone a polvos mds de los limiter recomendados, use proteccion respiratoria.
Primeros auxilios: En caso de contacto en los ojos, inmediatamente tluya agua en la parte afectada por 15 minutos.
Si se inhala polvo, expongase a aire fresco. Si el cemento fresco tiene contacto con sus ojos,ldvelos a Tondo con
agua. Acuda a atencion medica inmediatamente si ]a irritacion continua.
CEMEX, Memorial Hermann Tower
929 Gessner, Suite 1900
V7 combinado Houston, Texas 77024
02/12 Para mds informacion visita www.cemexusa.corn.