HomeMy WebLinkAboutCemex 4th PourCustomer Cr
L -22 ,1, 9
Project Code
Ticket Date:
i Delivery Ins4
f^ "4 i�
v'r•t 1 .
is
LOAD CUMULATIVE I ORDERED MATERIAL CODE PRODUCTION DESCRIPTION UOM UNIT PRICE AMOUNT
QUANTITY QUANTITY QUANTITY
.(0. <<;{_: C11"'G. ilr.a �".i'�; '! J �' "i';=tc.�?i F`CC�Ik-!;'NF?/�7 Ia 5L.F Et
f= fi4�
ApIr
I COMEX
ob: Start Unload: Finish Unload
c� 5
Customer Job Number:
Project P.O. Number:
Leave Job: I Return Plant:
Order Code / Date:
457 08/15/14
Order P.O. Number:
Map Page: Map/Row/Column:
Dispatcher:
5—H %LLIC 1 NEC
Ticket Number:
On Job:
Slump:
Truck Number:
Driver Number:
Driver Name:
End Use:
1Due
6. 30
;�,� 30 1
j:}o64t54.9 i
1:�94<i="3 Fan�1%L:i..
i7EL_A CORRE
B!_DNG . SLAB
.{;;M'()2e' 1.9 ENV 1, R,0Ni1C:N T P)L_ G#-lAFiG E
Cash Check # /Auth Code: I Signature of Driver Receiving Cash:
Check
--- WATER ADDED
OCT 10 RECD
Cash Received: Total COD Order Amount to Collect
Without Standby Charges:
GAL YARDS IN DRUM:
WHEN ADDED.
CURB LINE CROSSED AT OWNER'S/AGENT'S REQUEST:
SIGNATURE
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 F artdling information, and to the material safety data sheets for additional information.
returned coCI-M
ncrete. Buyers exceptions and claims shall be deemed waived unless mad_ a to us in writing AUTHORIZED SIGNATURE:
within one business day after the receipt of materials. O
'—fit'+ NUMNUMNIVERSAL ='REV : RK g INVOICE " j' /
This Delivery Ticket incorporates herein by reference Buyer's previously executer' C-edit Application, if any, Seller's Standard
Terms and. Conditions, Seller's Quotas if any, and Seller's Order Confirmation uding limitations of warranties), as if fully'
set forth on this Delivery Ticket ("Agr__...,-nt"). 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. Lf 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 do entrega incluye Como referencia al comprador (ya previamente ejecutada en su aplicaci6n de credito); cualqu.ier
termino estindar, condiciones del vendedor, propuestas del vendedor y orden de confirmaeion del vendedor (con limitaciones y
garantfas), como acuerdo total del ticket de entrega ("Contrato"). El vendedor proveerd los terminos estdndares y condiciones detal-
lados en caso de asf ser requeridos. Con este documento, el cornprador 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 contrato: 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 volednica, 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. L,os 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 rods de 0.025% de silicio cristalino.
Peligros: Mezcla de cemento fresco y/o cenizas volantes pueden causar irritacion en los Ojos, quemaduras en piel y ojos, y
reacciones alergicas en ]a pie] . 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, torte y/o perforac.i6n puede contener materiales
silicon, los cuales pueden causar silicosis pulmonar y cancer si son inhalados. En caso de ser ingeridos, mantenerse
en temperatura calida, reposar y tornar grandes cantidades de aqua. Las cenizas volantes pueden contener amoniaco.
Seguridad• La humedad puede causar la l.iberaci6n del amoniaco. La inhalation del amoniaco puede causar toner, irritacion o
quemaduras en la nariz, garganta y puhnones. Acud.ir inmediatamente al medico. El .riesgo en la salad depende en
]a duration y el nive] do 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. Lavese las manor 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, inmediatamente fluya agua en la paste afectada por 15 minutos.
Si se inhala polvo, expongase a aire fresco. Si el cemento fresco tiene contacto con sus ojos, lavelos a fondo con
agua. Acuda a atenci6n m6dica inmediatamente si la irritacion continua.
CEMEX, Memorial Hermann Tower
929 Gessner, Suite 1900
V7 combinado Houston, Texas 77024
02/12 Para aids information visita www.cemexusa.com.
t
Financial Project No.: N/A
F.D.O.T. Plant No.:. N/A
Concrete Supplier: CEMEX
Address: 6160 Midway Road
Ft. Pierce, FL 34981
Serial No.:
33302943
Date:
August 15, 2014
Delivered To:
Day & Zimmermen
Address:
5601 Ocean .Blvd
FPL Nuclear Plant
Truck No.
Class
Mix No.
Cubic Yards (M3) This Load
64589
5000
1572119
Time Loaded
Arriv+�ed
Discha`g O
Cubic Yards (M3) Total
5:37
`/ ,Qu
Allowable Jobsite Water Addition
720
Jobsite Slump
Jobsite w/c Ratio
DAREX
Cement CEMEX TYPE II
5810
WR GRACE
N/A
Brand
Amount
Source
Amount
WR GRACE
Coarse Agl 87-090 1.3%
17120
WRDA60
704
Pit # % Moist.
Amount
Source
Amount
WR Grace
Fine Agg. 87-090 4.0%
13320
ADVA 120
352
Pit # % Moist.
Amount
Source
Amount
Propex
Batch Water (Gals)
212
300 Fiber
15
Amount
Source
Amount
issuance or finis ticket constitutes cerntication that the concrete batched was produced
information recorded in compliance with Department specification requirements (347
of
Water added at Jobsite Gal./Liters
Issuance of this ticket constitutes certification that the maximum specified water cementitious
ratio was not exceeded and the batch was delivered and placed i ompliance with epartment
specification requirements (347-5)
Signature of Contra ors
Plant: '
:Begin Loading':.
dJO' 6:
Arrive'Job., ' .:
, Starwriload:i'
Finish Unload:
Leave Job:
Return Plant:
` 2/ 1.0rri'
Customer Code: .Customer Name: Customer Job Number: Order Code / Date:
DAY r Z IMMEFiMAN NPS 3.NC LF57 t3811 51 1 4
Project Code; Project . ° , t �. . _ ° _ � _ � . ° `,Project P.O: Number: . Order P.O, Number: °
•c
rEVE
s
Ticket Date: Delivery Address: Map Page: Map/Row/Column:
t_a8 1 j'f 1,4 1-6-()l N OC AN RJR F'��1_
Delivery InstruCGons - ' e Dispatcher
Ticket Number:
k a >
o
LOAD CUMULATIVE ORDERED MATERIAL CODE PRODUCTION DESCRIPTION UOM UNIT PRICE AMOUNT
QUANTITY QUANTITY QUANTITY
,
1F>;rb '7fit, , IMCd41I FiiD�IMEN'TAL.. C'HARi;E
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.
CURB LINE CROSSED AT OWNER'S/AGENT'S REQUEST:
c SIGNATURE
❑ LOAD WAS TESTED BY:
Notice: Our dfivers 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 dzerdous 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 andf g information, and to the m taYjal safety data sheets for additional information.
returned concrete. Buyers exceptions and claims shall be deemed waived unless made to us in writing AUT OJJJjjjI'pD7f]�TURE.
within one business dayafter the receipt of materials. r` � 1
6BUNIVERSAL I, REV TRK: 1006.4589 INVOICE LOAD NUM a �/
This Delivery Ticket incorporates here;- Ily reference Buyer's previously executec' "-,dit Application, if any, Seller's Standard:
Terms and Conditions, Seller's Quotat if any, and Seller's Order Confirmation ( idina limitations of warranties), as if fully
set forth on this Delivery Ticket ("Agreement"). Seller will provide the Standard Terms and Conditions upon request. Buyer agrees
that, unless otherwise noted on the front hereof, ail quantities and items were delivered as indicated and further expressly agrees to
pay in accordance. with,the Agreement.
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.centexusa.com.
Este ticket de entrega incluye como referencia al comprador (ya previamente ejecutada en su aplicaci6n de cr6dito); cualquiet
t6ni ino 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 terminos estandares y condiciones detal-
lados en caso de asf ser requeridos. Con este documento, el comprador acepta los mismo.s 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 rota al frente de este documento.
AGREGADOS / CEMENTO / PRODUCTOS DE CO NCRETO / CENIZAS VOLANTES
Los productos de agregados son materiales naturales como piedra caliza, dolomita, granito, roca!volcanica, arena, grava. y otros
materiales sil.ic.ios. Los productos de cemento incluyen Cemento de tipo Portland, de albariilerfa, pozzolan (tipo IP), azulejo de
azotea y estuco. Los productos de concreto incluyen cemento Portland y prod-uctos de agregados como piedra caliza, dolomita,
granito, rota volcanica, arena, grava, y otros materiales silicios. Estos productos incluyen cenizas volantes (fly ash) la coal puede
contener mds de 0.025% de silicoo cristalino.
Peligros: Mezcla de cemento fresco y/o cenizas volantes pueden causar irritaci6n en los ojos, quemaduras en piel y ojos, y
reacciones ale.rgi.cas en la pixel. Concreto seco y polvo de agregados, pueden causar irritaciion en .los Ojos, piel y/o en
la zona respiratoria. Polvo del manejo en el trituramiento, pulido, corte y/o perforaci6n puede contener materiales
silicon, los cuales pueden causar silicosis pulmonar y cancer si son inhalados. En caso de ser ingeridos, mantenerse
en temperatura calida, reposar y tomar grancles cantidades de aqua. Las cenizas volantes pueden contener amoniaco.
Seguridad: La humedad puede causar la .liberaci6n del amoniaco. La inhalaci6n del amoniaco ;puede causar toser, irritacion o
quemaduras en la nariz, garganta y pulmones. Acudir inmediatamente al medico. El riesgo en la salad depende en
la duraci6n y el nivel de la exposici6n.
Seguridad: Evi:te el contacto con ojos y contacto prolongado con la piel. Use guantes, protecci6n en los Ojos y ropa
Primeros adecuada para protecci6n. Ldvese las menos con jab6n suave y agua despues del manejo de materiales. Evite inhalar
auxilios• polvos. Si se expone a polvos mas de los limites reconrendados, use protecci6n 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 e1 cemento fresco tiene contacto con sus ojos, ldvelos a Tondo con
agua. Acuda a atenci6n medi.ca inmediatamente si la irritacion continua.
CF_,MEX., Memorial Hermann Tower
929 Gessner, Suite 1900
V7 conrbinado Houston. Texas 77024
02/12 Para mas informacion visita www.cemexusa.corn.
Financial Project No.: N/A
F.D.O.T. Plant No.: N/A'
Concrete Supplier: CEMEX.
Address: 6100 Midway Road
Ft. Pierce, FL 34981
not
Serial No.:
Date:
33302995
August 15, 2014
Delivered To: Day & Zimmermen
Address: 5601 Ocean Blvd
FPL Nuclear Plant
Truck No.
Class
Mix No.
Cubic Yards (M3) This Load
64924
5000
1572119
10
Time Loaded
Arrixe ,
Discharged
Cubic Yards (M3) Total
6:12
6 � oo
0r7,' D
20
Allowable Jobsite Water Addition
Slump
JJobsite w/c Ratio
21
JJobsite
DAREX
Cement CEMEX TYPE II
5810
WR GRACE
N/A
Brand
Amount
Source
Amount
WR GRACE
Coarse Agl 87-090 1.3%
17080
WRDA60
703
Pit # % Moist.
Amount
Source
Amount
WR Grace
Fine Agg. 87-090 4.0%
13320
ADVA 120
353
Pit # % Moist.
Amount
Source
Amount
Propex
Batch Water (Gals)
211
300 Fiber
15
Amount
Source
Amount
Issuance of this ticket constitutes certification that_the concrete batched was produced
information recorded in compliance with Department specification requirements (347-
Sign of Plant Batcher
Water added at Jobsite Gal./Liters
Issuance of this ticket constitutes certification that the maximum specified water cementitious
ratio was not exceeded and the batch was delivered and placed i compliance with Department
specification requirements (347-5)
Signature of Contractors
W
If ,
Plant:
Begin' Loading:
To Job:"
Arrive Job.
$tart Unload:
Finish Unload:
Leave -Job:
Return Plant:
9 / 1 {. 92
Customer Code::
Customer Name:
Customer Job Number:
Order Code] Date:
3 12 49
DPY & ? T MME RN4AN t4PS
INC
457 t f 8/ 1. 5/ 14
Project Code:
�= Project Name .
Project P,O.,Number:
oOrder P.O. Number: , `
Ticket Date:
Delivery Address:
Map Page: Map/Row/Column
0.8/ A •5.1,# 14
5601. N 0CEAN DR EPi_.
Delivery Instructions
-
:
�D^iisppatcher: CSEAM
}
. ^
Ticket Number:
7,33 3107
f�
Due On Job:
Slump:
Truck Number:
Driver Number:.
Driver Name:
End Use:
t 9 ,���
kip 5(! f
{�t(j 2 C.�3wt:Y 1
I./'�G't��4 p:�t,1E
l i EM a
B1_DNV o SLAB
LOAD
QUANTITY
J Cash
] Check
Charge
Comments:
CUMULATIVE ORDERED MATERIAL CODE PRODUCTION DESCRIPTION UOM
QUANTITY QUANTITY
56. 00 1 5'/ 2 k.tr 50REG/f-9/1""B/67 -,. ova LB F °tn ,
1 c 0;t 74`E lY L RCINMPE rrAL CHARGE
Check # / Auth Code: I Signature of Driver Receiving. Cash: Cash Received:
UNIT PRICE AMOUNT
i
. i
Total COD Order Amount to Collect
Without Standby Charges:
WATER ADDED: GAL YARDS IN DRUM:
WHEN ADDED.
SIGNATURE
CURB LINE CROSSED AT OWNER'S/AGENT'S REQUEST:
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 ha ling information, and to the aerial safety data sheets for additional information.
returned concrete. Buyers exceptions and claims shall be deemed waived unless made to us in writing AUTHO I SIGNATURE: ,
within one business day after the receipt of materials. O ® Q A (,� '^ p
68UNIVERSAL PRE11 TR1i; 1 t 0C.,4.924
INVOICE
LOAD NUN: 3
This Delivery Ticket incorporates herein by reference Buyer's previously executed r'-Pdit Application, if any, Seller's Standard
Terms and Conditions, Seller's Quotat. if any, and Seller's Order Confirmation ( iding limitations of warranties), as if fully `
set forth on this Delivery Ticket ("Agre.,,��,nt"). Seller will provide the Standard Tens 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 10 ENT / 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.cemj,.x a corn.
Este ticket de entrega incluye corno referencia al comprado.r (ya previarnente ejecutada en su aplic4ci6n de credito); cualquiea
t6rmino estandar, condiciones del vendedor, propuestas del vendedor y orden-de confirmaci6n del vendedor (con limitaciones y
garantfas), corno acuerdo total del ticket de entrega ("Contrato" ). El vendedor proveera los terrninos estandares y condiciones detal-
lados en caso de asf ser requeridos. Con este documento, el comp.rador acepta los m.ismos ya antes menc.ionados y que ]as cantidades
y materiales fueron entregados corno se expresa en el mismo. Acepta pagar el monto de acuerdo a] contacto: 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 naturaley corno piedra caliza, dolomita, granito, coca volcanica, arena, grava y otros
materiales silicios. Los productos de cemento incluyen Cemento de tipo Portland, de albanilerfa, pozzolan (tipo 1P), azulejo de
azotea y estuco. Los productos de concreto incluyen cemento Portland y productos de agregados como piedra caliza, dolornita.
granito, roca voledn.ica, arena, grava, y otros materiales silicios. Estos productos incluyen cenizas volantes (fly ash) la dual puede
contener mas de 0.025% de silicio crista:l.ino. i
Peligros: Mezela de cemento fresco y/o cenizas volantes pueden causar irritaci6n en los Ojos, quemaduras en piel y ojos, y
reacciones alergicas en la pie]. Conc.reto seco y polvo de agregados, pueden causar irritaci6n en losojos, piel y/o en
la zona .respiratoria. Po.lvo del manejo en el trituramiento, pu.lido, corte y/o perforaci6n pued-e contener materiales
silicos, los cuales pueden causar silicosis pulmonar y cancer si son inhalados. En caso de ser ingeridos, mantenerse
on temperatura calida, reposar y tomar grandes cantidades de agua. Las cenizas volantes pueden contener amoniaco.
Seguridad• La hurneclad puede causar la liberaci6n del amoniaco. La .inhalaci6n del amoniaco puede causar toSe.r, irritaci6n o
quem.aduras en la nariz, garganta y pulmones. Acud.ir inmediatamente al medico. El .riesgo en la salad depende on
la duraci6n y el nivel de la exposici6n.
Seguridad: Evite el contacto con ojos y contacto pro.longado con la piel. Use guantes, protecci.6n en los ojos y .ropa
Primeros adecuada para protecci6n. Lavese las manes con jab6n suave y agua despues del manejo de materiales..Evite i.nhalar
auxilios• polvos. Si se expone a polvos mas de los limites recomendados, use protecci6n respiratoria.
Prim.eros auxi..l.ios: En caso de contacto en los ojos, imnediatamente fluya agua en ]a parte afectada por 15 minutos.
Si se inhala polvo, exp6ngase a Aire fresco. Si el cemento fresco tiene contacto con sus ojos, lavelos a Tondo con
agua. Acuda a atenci6n medica inmediatamente si la irritaci6n continua.
CEMEX, Memorial Hermann Tower
929 Gessner. Suite 1900
V7 combinado Houston, Texas 77024
02/12 Para inns informati6n visita www.cemexusa.com.
Financial Project No.: N/A Serial No.:
F.D.O.T. Plant No.:
N/A
Concrete Supplier: CEMEX
Address: 6100 Midway Road
Ft. Pierce, FL 34981
33303107
Date: August 15, 2014
Delivered To: Day & Zimmermen
Address: 5601 Ocean Blvd
FPL Nuclear Plant
Truck No.
Class
Mix No.
Cubic Yards (M3) This Load
25332
5000
1572119
10
Time Loaded
Arrived
Discp�arged. ,
Cubic Yards (M3) Total
6:43
0 r, 0
� �e v i `b
30
Allowable Jobsite Water Addition
Jobsite Slump
Jobsite w/c Ratio
22
DAREX
Cement CEMEX TYPE II
5810
WR GRACE
N/A
Brand
Amount
Source
Amount
WR GRACE
Coarse Agl 87-090 1.3%
'17080
WRDA60
704
Pit # % Moist.
Amount
Source
Amount
WR Grace
Fine Agg. 87-090 4.0%
13320
ADVA 120
353
Pit # % Moist.
Amount
Source
Amount
Propex
Batch Water (Gals)
210
300 Fiber
15
Amount
Source
Amount
Issuance of this ticket constitutes certification that the concrete batched was produced an
information recorded in compliance with Department specification requirements (347-5 .
Si re of Plant Batcher
Water added at Jobsite Gal./Liters
Issuance of this ticket constitutes certification that the maximum specified water cementitious
ratio was not exceeded and the batch was delivered and placed in compliance with Department.
specification requirements (347-5)
dvJ�
Signature of Contractors
V
D
I
CEmcx 56842039
Plant:
Begin toading:
To Job:
Arrive Job:
Start Unload:
Finish Unload ;''
Leave Job:
Return Plant:
Customer Code: Customer Name: Customer JoblNumber: Order Code I Date:
312; F4'--4 5 DAY g ZIMMERMAN t+iPS INC 457 08/1 r/14
Project Code: Project Name;_ Project P.O. Number: Order P.O. Number.
STEVE
Ticket Date: Delivery Address: Map Page', Map/Row/Column:
08/ 15/ 14 1-3_601 N OCEAN DR FPI.-
Delivery 'Instructions: Dispatcher:
G"TE_DCS'E Ms
_ Ticket Number:
ti
1 33,3o7,298
�
C
LOAD CUMULATIVE ORDERED MATERIAL CODE PRODUCTION DESCRIPTION UOM UNIT PRICE AMOUNT
QUANTITY QUANTITY QUANTITY
.10.. 00 40. 00 56, C)C) 1.5721119 9000 REC3/H/Frn.,/G7 10 5 L..B 6= ` D3
Due On Job:
i
Slump:
Truck Number:
Driver Number:
FDriver Name:
End Use:
"'.
re `3a:3 1
tata; 1 a t 1
C���i:'('i7 IJ�i`!NY
MALONE
BLDNG a .SLAB
1, tit:) 1247818 FUEL. SURCHARGE
1.00 1202749 NV I RONMENTAL CHARGE.
I
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
CURB LINE CROSSED AT OWNER'S/AGENT'S REQUEST:
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 hqn ling information, and to the 2teterial safety data sheets for additional information.
returned concrete. Buyers exceptions and claims shall be deemed waived unless made to us in writing AUTH III D `SAIGNATURE: /
within one business day after the receipt of materials. O A/ h XR
68UNIVERSAL PREV TRI-,a 10025332 INVOICE
L-OAD NUM: 4 �\
This Delivery Ticket incorporates herei^ h., reference Buyer's previously executed (r-dit Application, if any, Seller's Standard
Terms and Conditions, Seller's Quotatic any, and. Seller's Order Confirmation (i ling limitations of warranties), as .if fully
set forth on this Delivery Ticket ("Agreeinuitt"). Seller will provide the Standard Terms mid 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. I' 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 Como referencia al comprador (ya previamente ejecutada en su aplicaci6n 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 proveerd los tenninos estandares y condiciones detal-
lados en caso de asf ser requeridos. Con este documento, el comprador acepta los mismos ya antes mencionados y que ]as cantidades
y materiales fueron entregados como se expresa en el mismo. Acepta pagar el monto de acuerdo al contrato: al menos quo se identi-
fique con una nota al frent.e de este documento.
AGREGADOS / CEMENTO / PRODUCTOS DE CONCRETO / CENIZAS VOLANTES
Los productos de agregados son materiales naturales como piedra caliza, dolomita, granito, coca volcanica, 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, rota 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 alergicas en la pie]. Concreto seco y polvo de agregados, pueden causar irritaci6n en los ojos, piel y/o en
la zona respiratoria. Polvo del manejo en el trial rami onto, pulido, torte 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, irritation o
quemaduras en la nariz, garganta y pulmones. Acudir inmediatamente al medico. El riesgo en la salud depende en
la durac.i6n y el nivel de la exposici6n.
Seguridad: Ev.ite el contacto con ojos y contacto pro.longado con la piel. Use guantes, protecci6n en los ojos y ropa
Primeros adecuada para protecci.6n. Ldvese l.as manos con jab6n suave y agua despues del manejo de materiales. Evite inhalar
auxilios• polvos. Si se expone a polvos mds de los limiter recomendados, use protecci6n respiratoria.
Primeros auxilios: En caso de contacto en los ojos, inmediatamente fluya agua en la parte afectada por 15 minutos.
Si se inhala polvo, exp6ngasc a aire fresco. Si el cemento :fresco tiene contacto con sus ojos, lavelos a fondo con
agua. Acuda a atenci6n mCdica inmediatamente si la irritaci6n continda.
CEMEX, Memorial Hennann Tower
929 Gessner, Suite 1900
V7 combinado Houston, Texas 77024
02/12 Para mds informaci6n visita www.cemexusa.com.
ARM
Financial Project No.: N/A Serial No.:
F.D:O.T. Plant No.:
Concrete Supplier:
N/A
CEMEX
Address: 6100 Midway Road
Ft. Pierce, FL 34981
33303298
Date: August 15, 2014
Delivered To: Day & Zimmermen
Address: 5601 Ocean Blvd
FPL Nuclear Plant
Truck No.
Class
Mix No.
Cubic Yards (M3) This Load
25403
5000
1572119
10
Time Loaded
Arrive
-�
Disc red
Cubic Yards (M3) Total
7:35
U
.1j
40
Allowable Jobsite Water Addition
Jobsite Slump
Jobsite w/c Ratio
20
DAREX
Cement CEMEX TYPE II
5800
WR GRACE
N/A
Brand
Amount
Source
Amount
WR GRACE
Coarse Agl 87-090 1.3%
17080
WRDA60
703
Pit # % Moist.
Amount
Source
Amount
WR Grace
Fine Agg. 87-090 4.0%
13200
ADVA 120
353
Pit # % Moist.
Amount
Source
Amount
Propex
Batch Water (Gals)
212
300 Fiber
15
Amount
Source
Amount
Issuance of this ticket constitutes certification that the concrete batched was produced and
information recorded in compliance with Department specification requirements (347-5).
Signs ure of Plant Batcher
Water added at Jobsite Gal./Liters
Issuance of this ticket constitutes certification that the maximum specified water cementitious
ratio was not exceeded and the batch was delivered and placed in compliance with De artment
specification requirements (347-5)
Signature of Contractors
r-
1AW. Ccmcx . - 42 1
Plant:.
Begin; Loading:
To'Job:
Arrive Job:
;Start Unload:.
Finish Unload:
Leave Job:
Return Plant:
9 r 10 :7f
Customer Code: Customer Name: Customer Job Number: Order Code / Date:'
Pro aect Code: - ,Project Name: _` _ °. ° ° Project P.O. Number. V Order P.O ,Number. i
'Ticket Date: Delivery Address: Map Page: Map/Row/Column:
i Delivery Instrucfons: : . _ ." Dispatcher.,
Ticket Number:
` ¢ ° .r J 4 1
Due On Job:
Slump:
Truck Number:
Driver Number:
Driver Name:
End Use:
8A-.53
Go ,`. o 1Oo64581::3
Iw09•r."'.2
7 Ai',IGEL
DELATORRE
BLUING., SLAB
LOAD CUMULATIVE ORDERED MATERIAL CODE PRODUCTION DESCRIPTION UOM UNIT PRICE I AMOUNT
QUANTITY QUANTITY QUANTITY
LC, c3 ta'°u t;���r 5F C`0 �i: `�c 1 �,000 REG/H/FB/67
t o aytt t ;t , 18 E; U L. SURCHARGE
CHARGE
Cash Check # I Auth Code: Signature. of Driver Receiving Cash:
Check "
a
Charge
Comments:
10 5 t LA F YD'3 .
i
ID Order Amount to Collect
Standby Charges:
WATER ADDED: GAL YARDS IN DRUM:
WHEN ADDED.
*, SIGNATURE
CURB LINE CROSSED AT OWNER'S/AGENT'S REQUEST:
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
rcontrol after eturned concrete. Buyers exceptionsl and claims shall s deemed forwaived finished results. No credit for safety I;a idling information, and to the material safety data sheets for additional information.
delivery,Company� P Y responsibility
yunless made to us in writing AUTHOR SIGNATURE: //,
within one business day after the receipt of materials. O 1, 0 i�, A„ A 0 ! �n e i \ ei p,r
6BUNIVERSAL PREY TRK: 1 0f:1i::54f t3
INVOICE
L_01216 NUI-41 °o 5 r
This Delivery Ticket incorporates here;- by reference Buyer's previously executed '--dit Application, if any, Seller's Standard'
Terms and. Conditions, Seller's Quotati f any, and Seller's Order Confirmation (: ding limitations of warranties), as if fully
set forth on this Delivery Ticket ("Agreement"). 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 / FLi 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 sil..iceous 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 imitation 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 IVMSDS), 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
02/1.2 For more information please visit www.cemexusa.com
Este ticket de entrega incluye como referencia. al comprador (ya previa nente ejecutada en su aplicaci6n de crcdito); cualquier
t6rmino estandar, condiciones del vendedor, propuestas del vendedor y orden de confirmaci6n del vendedor (con lirnitaciones y
garantfas), como acuerdo total del ticket de entrega ("Contrato"). El vendedor proveera los t6rminos estandares y condiciones detal=
lados en caso de as% ser requeridos. Cori este documento, el comprador acepta los mismos ya antes mencionados y que ]as cantidades
y materiales fueron entregados como se exp.resa en el mismo. Acepta pagar el. monto de acuerdo al contacto: 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, rota volcanica, arena, gravy 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, coca volcanica, arena, grava, y otros materiales silicios. Estos productos incluyen cenizas volantes (fly ash) la cual puede
contener mas de 0.025% de silicio eristalino.
Peligros: Mezcla de cemento fresco y/o cenizas volantes pueden causar irritaci6n en los ojos, quemaduras en piel y ojos, y
reacciones alergicas en ]a pier. Concreto seco y polvo de agregados, pueden causar irritaci6n en los ojos, piel y/o en
la zona .respiratori.a. Po.lvo del manejo en el trturamiento, pulido, corte y/o perforac.i6n 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
quem.aduras en la nariz, garganta y puhmnes. Acud.ir 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 la piel. Use guantes, protecci6n en los ojos y ropa
Primeros adecuada para protecci6n. Lavese las rnanos con jab6n suave y agua despues del manejo de materiales. Evite inhalar
auxilios• polvos. Si se expone a polvos rods de los limites recomendados, use protecci6n respiratoria.
Pri_meros auxilios: En caso de contacto en los ojos, inmediatamente fluya agua en la parte afectada por 15 minAtoS.
Si se .inhala polvo, exp6ngase a aire fresco. Si el cemento fresco tiene contacto con sus ojos, lavelos a fondo con
agua. Acuda a at.enci6n medica inmediatamente si la irritaci6n continua.
CEMEX, Memorial Hermann Tower
929 Gessner, Suite 1900
V7 combinado Houston, Texas 77024
02/12 Para mas informacion visita www.cemexusa.com.
Financial Project No.: N/A
F.D.O.T. Plant No.: N/A
Concrete Supplier: CEMEX
Address: 6100 Midway Road
Ft. Pierce, FL 34981
Serial No.:
33303423
Date:
August 15, 2014
Delivered To:
Day & Zimmermen
Address:
5601 Ocean Blvd
FPL Nuclear Plant
Truck No.
Class
Mix No.
Cubic Yards (M3) This Load
64589
5000
1572119
10
Time Loaded
Arrive
Discharg d
Cubic Yards (M3) Total
8.03
� :
50
Allowable Jobsite Water Addition
lJobsite Slump
lJobsite w/c Ratio
21
DAREX
Cement CEMEX TYPE II
5800
WR GRACE
N/A
Brand
Amount
Source
Amount
WR GRACE
Coarse Ag! 87-090 1.3%
17080
WRDA60
703
Pit # % Moist.
Amount
Source
Amount
WR Grace,'
Fine Agg. 87-090 4.0%
13200
ADVA 1.20
353
Pit # % Moist.
Amount
Source
Amount
Propex
Batch Water (Gals)
211
300 Fiber
15
Amount
Source
Amount
Issuance of this ticket constitutes certification that the concrete batched was proaucea ana
information recorded in compliance with Department specification requirements -
Signature of Plant Batcher
Water added at Jobsite Gal./Liters
Issuance of this ticket constitutes certification that the maximum specified water cementitious
ratio was not exceeded and the batch was delivered and placed in compliance with Department
specification requirements (347-5) hAmy', CDWX�
Si ature of Contractors
Plant:
Begin Loading:
To Job:
Arrive Job:
Start Unload:
Finish Unload:
Leave Job:
Return Plant:
'D : ! 10 9 i-:
Customer Code:
Customer Name:
3 122495
DAY & tIttlMERMAN IMPS
INC
+ Project Code:
Project Name:
Ticket Date:
Delivery Address:
, . t ia/ 1. i / 14
5601 N OCEAN DR — IrI7AI—
bePvery Instructions:
f1}'' T E C
i
r'
t_
Customer Job Number: Order Code / Date:
i� 5T i3a.~:,! 15" 14
Project P.O. Number: Order P.O. Number:
�� l EVE
Map Page: Map/Row/Column:
Dispatcher:
DCSE MS
Ticket Number:
3w,,3.,t. 361 r?
i
Due On Job:
Slump:
Truck Number:
Driver Number:
Driver Name:
End Use:
'i
E� o t:i i
i zt aF,4 �.:� a.
t?' �_i_?�; T%1NY
ANTON 1CC I
BLDNG a SLAB
LOAD CUMULATIVE I ORDERED MATERIAL CODE PRODUCTION DESCRIPTION UOM UNIT PRICE I AMOUNT
QUANTITY QUANTITY QUANTITY
.e.6;0 56. rlt� E,. r:tt'r 15721 ir: rt1¢� 7 REG/H/ / 7 1> LB€= `,'I1�
1.00 12'47818 FUEL. SURCHARGE:
1. 00 1202749 eNV I RC11'lMENTAL CHARGE
Cash Check # / Auth Code: Signature of Driver Receiving Cash: Cash Received: Total COD Order Amount to Collect
Without Standby Charges:
Check
Charge
Comments
WATERADDED
GAL YARDS IN DRUM:
WHEN ADDED.
SIGNATURE
CURB LINE CROSSED AT OWNER'S/AGENT'S REQUEST:
SIGNATURE
❑ LOAD WAS TESTED BY:
Notice: Our divers 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 h n ng information, and to the m te�ial safety data sheets for additional information.
returned concrete. Buyers exceptions and claims shall be deemed waived unless made to us in writing AAUUTHO IZ D{Mi
ATURE. '
within one business day after the receipt of materials. ..
66UNIVERSAL f-rREV RKe 1t O 4- 89 INVOICE LOAD NUIYI6
'ay
This Delivery Ticket incorporates here:- `w reference Buyer's previously executed "--dit Application, if any, Seller's Standard
Terms and Conditions, Seller's Quotatii f any, and Seller's Order Confirmation (i ding limitations of warranties), as if fully
set forth on this Delivery Ticket ("Agreement"). 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 rearm, 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 comprador (ya previamente ejecutada en su aplicacion de credito): cual.quier
termino estindar, condiciones del vendedor, propuestas del vendedor y orden de confirmation del vendedor (con limitaciones y
garantfas), comp acuerdo total del ticket de entrega ("Contrato"). El vendedor proveera los terrninos estandares 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 contacto: 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, coca volcanica, 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, rota volcanica, arena, grava, y otros materiales silicios. Estos productos incluyen cenizas volantes (fly ash) la coal puede
contener mhs de 0.025% de silicio cristalino.
Peligros: Mezcla de cemento fresco y/o cenizas volantes pueden causar irritacion en los ojos, quemaduras en pies y ojos, y
reacciones ale.rgicas en ]a piel.. Concreto 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, torte 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 cdlida, reposar y tomar grandes cantidades de aqua. Las cenizas volantes pueden contener amoniaco.
Se uridad• La humedad puede causar la liberation del amoniaco. La inhalaci6u del amoniaco puede causar toser, irritacion o
g quemaduras en la nariz, garganta y pulmones. Acudir inmediatamente al medico. El riesgo en la salad depende en
la duration y el nivel de la exposition.
Seguridad: Evite el contacto con ojos y contacto prolongado con la piel. Use guantes, protecei6n en los ojos y ropa
Primeros adecuada para proteccion. Lavese las manos con jabon suave y agua despues del manejo de materiales. Evite inhalar
auxilios• polvos. Si se expone a polvos rnas de los limites recomendados, use proteccion respiratoria.
Primeros auxilios: En caso de contacto en los ojos, inmediatamente fluya 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, lavelos a fondo con
agua. Acuda a atenci6n medica inmediatamente si la irritacion continua.
CEMEX, Memorial Hermann Tower
929 Gessner, Stiite 1900
V7 combinado Houston, Texas 77024
02/12 Para mas information visita www.cemexusa.com.
Financial Project No.: . N/A Serial No.:
F.D.O.T. Plant No.:
Concrete Supplier:
N/A Date:
CEMEX
Address: 6100 Midway Road
Ft. Pierce, FL 34981
33303619
August 15, 2014
Delivered To: Day & Zimmermen
Address: 5601 Ocean Blvd
FPL Nuclear Plant
Truck No.
Class
Mix No.
Cubic Yards (M3) This Load
64623
5000
1572119
6
Time Loaded
Arriv
Discharged
Cubic Yards (M3) Total
8:56
;
56
Allowable Jobsite Water Addition
Jobsite Slump
Jobsite w/c Ratio
13
DAREX
Cement CEMEX TYPE II
3490
WR GRACE
N/A
Brand
Amount
Source
Amount
WR GRACE
Coarse Agl 87-090 1.3%
10240
WRDA60
423
Pit # % Moist.
Amount
Source
Amount
WR Grace
Fine Agg. 87-090 4.0%
8000
ADVA 120
213
Pit # % Moist.
Amount
Source
Amount
Propex
[Batch Water (Gals)
126
300 Fiber
9
Amount
Source
Amount
Issuance of this ticket constitutes certification that the concrete batched was produced and
information recorded in compliance with Department specification requirements (347-5)
Signature of Plant Batcher
Water added at Jobsite Gal./Liters
Issuance of this ticket constitutes certification that the maximum specified water cementitious
ratio was not exceeded and the batch was delivered and placed i ompliance wit partment
specification requirements (347-5)
Si ature of Contractors