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090 11 1090
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Customer Code: Customer Name:
,. 1.o7606 , PlEL —RY CON9TRUCTION
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project Code: �--,-,Project N.ame.: `
Ticket Date: _ Delivery Address:
0 7 /01 / 13 1 o7o 1 G OCEAN DR. LOT*- 9212
Delivery Instructions:
i 11-401-ADAY OUT ON THE ISLAND'
1 4
Customer Job Number: Order Code / Date:
2C,1-1445 a6i�`. 0e i
Project P.O. Number: Order P.O. Number: ,
Map Page: Map/Row/Column:
Dispatcher:
GFarIn t
Ticket Number:
326657 76
Due On Job:_
Slump:
Truck Number:
Driver Number:
Driver Name:
End Use:
J. 20 30
5. c_}I }
i �_}C)2 399
109008
GREG WILLIAMS
_ _
BL_C7NG o O I h-!k- i'
LOAD CUMULATIVE ORDERED MATERIAL CODE PRODUCTION DESCRIPTION UOM UNIT PRICE AMOUNT
QUANTITY QUANTITY QUANTITY
0
O. 06 V)n 00 10 497 30 0 RI C3 ° D3
1n 00 :+. j 7 �.t3 FUEL. SURCHARGE
1 y 0(1 1202749 ENV I RONME i -mi._ CHARGEJUL I Aml1a46
Cash Check # / Auth Code: Signature of Driver Receiving Cash: Cash Received: Total COD Order Amount to Collect
Without Standby Charges:
Check
ADDED: /.�w�_GAL YARDS IN DRUM:
el"' ,9 % WHEN ADDED.
CURB LINE CROSSED AT OWNER'S/AGENT'S REQUEST\-R
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 hanolir%g 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: '
within one business day after the receipt of materials. O % /�
t r
68UNIVERSAL P'REV . TRH' " INVOICE LOAD NUM a 1
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r ~) Delivery Ticket incorporates here ' ' iy reference Buyer's previously executes' `'--edit Application, if any, Seller's Standard
,rrms and Conditions, Seller's Quotat if any, and Seller's Order Confirmation ( ading ]_imitations of warranties), as if fully
yet forth on this Delivery Ticket ("Agreement"). Seller will provide the Standard Terms and Conditions upon request. Bul-r agrees
/"that, unless otherwise noted on the front hereof, all quantities and items were delivered as indicated and further expressly rees to
/ pay .in accordance with the Agreement.
y 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 wann, 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 1.5 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 include como teferencia at comp.rador (ya previamente ejecutada en su aplicaci6n de credito); cualquier
t6=-�na.estandar_condiciones del vendedor, propuestas del vendedor y orden de confirmation del vendedor (con limitations y
gar�antfas), como acuerdo total del tickef de entrega ("Contrato"). E; vcndedor'pfbveefa lds ter.mmos estanaares y condic':ones-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 d regados como se expresa en el mismo. Acepta pagar el monto de acuerdo at contacto; at menos que se identi-
fique con una nota at frente de este documento.
AUKLUAVOS /
YK011UUTOS DE UONUKETO / UENIZAS VOLAN'1'L+'S
Los productos de agregados sor dateriales .naturalls como p.iedra caliza, d.olomita, granito, roca 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, roca volcanica, arena, grava, y otros materiales silicios. Estos productos incluyen cenizas volantes (fly ash) la coal puede
contener mas de 0.025% de silicio cristalino.
Peligros: Mezela de cemento fresc6y/o cenizas volantes pueden causar irritacion en los ojos, quernaduras en pie[ y ojos, y
reacciones alergicas en la piel. Concreto seco y polvo de agregados, pueden causar irritacion en los Ojos, piel y/o en
la zona respirator.ia. Polvo del manejo en el trituramiento, pulido, torte y/o perforation 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 liberation del amoniaco. La inhalation del amoniaco puede causar toser, irritacion o
quemaduras en la nariz, garganta y pulmones. Acudir inmediatamente a]. medico. El riesgo en la salud depende en
la duration y el nivel de la exposition.
Seguridad: Evite el contacto con ojos y contacto prolongado con la piel. Use guantes, proteccion en los ojos y ropa
Primeros adecuada para proteccion. 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 proteccion respiratoria.
Primeros auxilios: En caso de contacto en .los ojos, inmediatamente fluya agua en la pane 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 medica inmediatamente si la irritacion continua.,
CEMEX, Memorial Hermann Tower
929 Gessner, Suite 1900
V7 combinado Houston, Texas 77024
02/12 Para mds information visita www.cemexLisa.com.
55779100
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LOAD CUMULATIVE ORDERED MATERIAL CODE PRODUCTION DESCRIPTION
QUANTRY QUANTITY CUANTtTY
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Signature of Driver Rar ewo cash:
Cash
Mr.
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OrderPA. Nlrmbcr:
Map Page: MapfRowlCok;mry
Dispatrher:
Ticket Number.
UOM I UNIT FMCS I AMOUNT
Total COD Order Amount to Collect
Wittw A Standby Charges:
WATER ADDED: -GAL YARDS IN DRUM:
WHEN ADDED.
SIGNATURE
CURB LINE CROSSED AT OWNER'SIAGENT'S R20UEST:
-� SIGNATURE
4 LOAD WAS TESTED BY:
Notice: oar drI m wig make every eflbd to Plaea mmtariots where the customer designates, but dre SPECIAL TERM$: Any water aged [sat &=mess own risk. If water is added onie4, wnaete atr®ngm
Company
t tlnt rt> Oft fbr damages inside Ovrb or property Una. Customer agrees to fhe IS no longer guaranteed. WARNING: Product may Was skin artmor eye itd�tion. CAwn% Material
wntml altar k" and accepts twMo as is. DUO to cnponam tafkms wNCh are out of our may be hamahm to your safety and hoaith, Please refer to the backside of this tirlkat for unpodant delivery, this CoMpany vA not accept any respw1*1blity for the Ortshad rMits_ NO credit for Safety handling iMarmatron, and to the material safety data Shasta for additional infnm lim
ratumad qP=M Buyers, e:Wptions and claims Shall be deemed webed urdess made to rm in writing AUTHORO SIGNATURE:
WIIhM One business day after the receipt of mft jeje,
SOUNIVEFISAL
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Cash Received:
Total COO Order Amount to Coosa
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tlYtthottt StaruWy Charges:
Comments;
WATERAOUED:-GAL
YARDS IN DRUM:
WHEN ADDED.
SIGNATURE
CURB LINE CROSSED AT OWNER'SIAGENrS REQUEST:
SIGNATURE
Q LOAD WAS TESTED BY:
Notice: Our drivers will moo every efl'ori to place materials wbare the customer designates, but the SPECIAL TPku8: Any water added IS at ousfamars awn dslc If water is added *AA. COMM strength
Cansfa11f assumes RO ,esponability for damages inside sub or properly Imo, Custpmer agreas to tlne ft no longer guaranteed, WARNING: Product may cause elfin aWor eye Driladon. CAUTION' Material
tenrra M 8AN end detwety and aooepts ooltcrete as is. Qua to rtrrpoltalrt facnora Wh rh are out of our may be raWdous to your eatery and health. Plesge refer to Uw backside of this Edfet for impotent
rmee Cvmyany wAI rid set�pi any rQsperosiDitiry (er the nnisfied rasftte. No creait ter saraty hand" information, and to the material safety data shoals for additional infomwtion.
eicdaptian3 and daitrrs eftae daenf9d wowed unless made to uo In writing AYTIiOR�0 SIGNATURE:
wlfebe or>a business day ettm'#hp recoiM of mBtattals.
BBUNIVERSAL rr RE tf i RK . f 0r_4:1 31 .Cot) NUP, : C.
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Cash Reid:
WATER ADDEM-GAL
Ordar Coda! Date:
pall (t i /i'—C/ 'I '
Order A0, Number.
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Map Page. maptRri molt' m :
dispatcher:
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TVckal Number. .
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UOM I UNITPRICE I AMOUNT
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Total COD Order Amount to Collect
Without standby charges:
YARDS IN DRUM:
WHEN ADDED.
SIGNATURE
CURB LINE CROSSED AT OWNERVAGENT'S REQUEST:
6laNATURE
O LOAD WAS TESTED BY:
NOW our drivers Wl0 MAO every effM to pie materials where the customer deti4ri8tes. but the SPECW. TOR"t Arty water added i5 at k M0lnar8 0M risk. I} wBtRr is added ort job. Coaaeffi BVertgfh
cwnmw 888U 9 no Mwomilbility for damages inside curb or pmparty line. Cu=mor agrees to the is no longer guaranteed. WARNING; Product may cause eku+ undfor eye Wtati m. CAUTIDN• Material
tarots of seta and ddWw ar4 a concrete as is. Rue to important fa$arb .which are out of our may be naza dous to your safety and health. Please refer to the baeuside of this ticket for important
anbd after delirmy+ ink Company wsl not atxept any rftWM W* for the finished results. No cr"4 for Sa* handling Information, and to the maWal Safely data sheets for additional Informoo n,
mUunad conacts Buyers exooptlorla and tdS1mS shall be deemed waived unless made to ug in writing AUTNOMMI) $IGNATURE:
trtft one business day after the recalpt of metodais.
68UNIVERSAL 11�':s 1] 'f l+Ir n —
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