HomeMy WebLinkAboutCemex Invoice-
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Plant:
Be In Loading-
To Job:
Arrive Job:
Start Unload:
Finish Unload:
Leave Job:
Return Plant:
Customer Code:
Customer Name:
Customer Job Number:
Order Code / Date:
,r,i;:'M SHELL C'31i !T?LI�,TGt�.� I.Idi,
Project Code:
Project Name:
Project P.O. Number..
Order P.O. Number.
Ticket Date:
Delivery
Map Page: Map/Row/Column:
/r}Address:
Delivery Instructions:
)�
Dispatcher:
Ticket Number:
JP r
IC
Due On Job:
Slump:
Truck Number:
Driver Number:
FDnv.r Name:
End Use:
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I LOAD CUMULATIVE I ORDERED MATERIAL CODE PRODUCT ON D
UANTITY QQUANTITY ' , I ESCRIPl�Oy ) UOM UNIT PRICE I AMOUNT
QUANTITY r
t f 'Itl :Jj .i SJ4 s,_ 1 1' ''.:ID I l /( i' I yv
i 1:.0E '.i 1-1- /) 110"i"il EN i 1•'Ir CHARGE
Cash Check # /Aulh Code: Signature of Driver Receiving Cash: Cash Received: Total COD Order Amount to Collect
Without Standby Charges:
Check
Charge /
Comments: r• , / /
'Z GAL YARDS IN DRUM:
1� WATERADDED: WHEN ADDED.
G � i
SIGNATURE
(� CURB LINE CROSSED AT OWNER'S/AGENT'S REQUEST:
c,1ri : c D TSf�j�►SA1— r-�EFA4-:1N
9I=1( If'!_ FULL i_ LEZAi' `iA1"]S
❑ LOAD WAS TESTED
Notice: Our drivers will make every effort to place materials where the customer designates, but the SPECIAL-�TERMS: Any water added
Company assumes no responsibility for damages inside curb or property line. Customer agrees to the is 9, longer guaranteed. WARNING:
terms of sale and delivery and accepts concrete as is. Due to important factors which are out of our may be hazardous to yourr safety-ap
control after delivery, this Company will not accept any responsibility for the finished results. No credit for satiety handling informatiog\.and to th
returned concrete. Buyers exceptions and claims shall be deemed waived unless made to us in writing A`HOR ZE° sk i RE,N—7
within one business day after the receipt of materials. rf
SIGNATURE
r
)iners own risk. If water is added on job, concrete strength
may cause skin and/or eye irritation. CAUTION: Material
Please refer to the backside of this ticket for important
W: CS:.S I Irl-eu
68UNIVERSAL INVOICE
This Delivery Ticket incorporates here;-- "y reference Buyer's previously executed Credit Application, if any, Seller's Standard
Terms and Conditions, Seller's Quotati, f any, and Seller's Order Confinnation (i ding limitations of warranties), as if fully
set forth on this Delivery Ticket ("Agret,,.,,nt"). Seller will provide the Standard Teri__.. _nd Conditions upon request. -Buyer agrees
that, unless otherwise noted on the front hereof, all quantities and items were delivered as indicated and further expresSl� 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 0.025% 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 at comprador (ya previamente ejecutada en su aplicac.i6n de credito): cualquier
t6rmino estandar, condiciones del vendedor, propuestas del vendedor y orden de confirmaci6n del vendedor (con limitaciones y
garantias), como acuerdo total del ticket de entrega ("Contrato"). El vendedor proveera los t6rminos 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 at contrato; at menos que se identi-
fique con una rota at 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, 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, 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 cristalino.
Peligros: Mezcla de cemento fresco y/o cenizas volantes pueden causar irritaci6n en los Ojos, quemaduras en piel y ojos, y
reacciones al6rgicas en la piel. Concreto seco y polvo de agregados, pueden causar irritaci6n en los ojos, pie] y/o en
la zona respiratoria. Polvo del manejo en el trituramiento, pulido, cone y/o perforaci6n puede contener materiales
silicos, Jos cuales pueden causar silicosis pul.monar 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 toser, initaci6n o
quemaduras en la nariz, garganta y pu.lmones. Acudir inmediatamente a] 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 Jos ojos y ropa
Primeros adecuada para protecci6n. Lavese las manor 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 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 el cemento fresco tiene contacto con sus ojos, lavelos a fondo con
agua. Acuda a atenci6n m6dica inmediatamente si la irritaci6n continua.
CEMEX. Memorial Hermann Tower
929 Gessner, Suite 1.900
V7 combinado Houston, Texas 77024
02/12 Para mds informaci6n visita www.cemexusa.com.
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CEMEX
5.7502542
Plant:
Begin Loading:
To Job:
Arrive Job:
Start`Unload:
Finish Unload:
Leave`Job:
Return Plant
Customer Code:
Customer Name:
.3 1 'p 7;?t�
ir�C t cHELL.. r.;i7fiiTfi €ACT,' NC,
Project Code:
Project Name:
Ticket Date:
Delivery Address:
i'-Q i 'W 6 / 15
=_ 3 o N fit 1. A
Instructions::
rD-elivery
Customer Job Number:
Project P.O. Number:
MAR 1 2 BECD D
Order Code / Date:
Order P.O. Number:
VERBAL
Map Page: Map/Row/Column:
Dispatcher:
SHK UC I NEB:
Ticket Number:
Due On Job:
Slump:
Truck Number.
Driver Number:
Driver Name:
End Use:
1 a 1 s
5. ,_;t.) . 1
0025760 1()
3228 POD
COLT MAN
BLDNG n EXT ',-3H L
LOAD
CUMULATIVE I
I.
ORDERED
MATERIAL CODE
PRODUCTION DESCRIPTION
UOM
UNIT PRICE
AMOUNT
QUANTITY
QUANTITY
QUANTITY
1 - `ems-818 F)JE•L_
SURCHARGE
G a ,'' 3�^},
1. u 00
CHARGE
1 5;'I1:'—H5'*'; SERV,
PA LCIt- D, 1.,,HARC E OVEK, 3 '-
Cash Check # / Auth Code:
Signature of Driver Receiving Cash:
Cash Received:
Total COD Order Amount to Collect
] Check
Without Standby Charges:
Charge
Comments:
WATERADDED: GAL
YARDS IN DRUM:
WHEN ADDED.
RECEIVED MAR 13-711115'
SIGNATURE
CURB LINE CROSSED AT OWNER'S/AGENT'S REQUEST:
ONCRETE DISPOSAL FEE SIGNATURE
PARTIAL _ ELit_,1_ L_Of"1D _ YARDS ❑ 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.
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
68UNIVERSAL PREV 'F RK: INVOICE LOAD NUM a I
This Deliver �'"� . ,orpo.rates herein by reference Buyer's previously executed Credit Application, if any, Seller's Standard.
Terms I ydMons, Sellers Quotation, ry, and Sellers Order Confirmation (incl ig limitations of warranties), as if fully
set foris Delivery Ticket ("Agreemi_ ). Seller will provide the Standard Terms — Conditions upon request. Buyer agrees
that"j.yr>ess otherwise noted on the front hereof, all quantities and items were delivered as indicated and further expressly agrees to
paf!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 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 i.ncluye como referencia al comprador (ya previamen.te ejecutada en su aplicac.i6n de cr6dito); cualquier
tdrmino estdndar, conditions del vendedor, propuestas del vendedor y orden de confirmation 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 requeri.dos. Con este documento, el com.prador acepta Jos 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 do agregados son materiales naturales como piedra caliza, dolomita, granito, rota 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 como piedra caliza, dollomita,
granito, .rota volcanica, arena, grava, y otros materiales silicios. Estos productos incluyen cenizas volantes (fly ash) la cual puede
contener nias de 0.025% de silicio cristalino.
Peligros: Mezcla de cemento fresco y/o cenizas volantes pueden causar irritation en los ojos, quemaduras en piel y ojos, y
reacciones al6rgicas en la piel. Concreto seco y polvo de agregados, pueden causar irritaci6n en los ojos, pie] y/o en
la zona respiratoria. Polvo del manejo en el trituramiento, pulido, torte y/o perforation puede contener materiales
silicas, Jos cuales pueden causar silicosis pu.lmonar y cdncer 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 liberation del amoniaco. La inhalation del amoniaco puede causar toser, irritation o
quemadurras en la nari.z, garganta y pulmones. Acudir inmediatamente al. medico. El riesgo en la sal.ud depende en
la duraci6n y el nivel de la exposici6n.
Seguridad: Evite el contacto con ojos y contacto prolongado-con la�p'i.e1.+�Tse`,'g40it X, protecci6n en los ojos y ropa
Primeros adecuada para protecci6n. Lavese las manor con jab6n suave y agua despues del. manejo de materiales. Ev.ite inhalar
auxilios: polvos. Si se expone a polvos mds de los limites recomendados, use protecci6n 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 airs fresco. Si el cemento fresco tiene contacto con sus ojos, lavelos a fondo con
agua. Acuda a atenci6n m6dica inmediatamente si la irritaci6n continua.
CEMEX, Memorial Hermann Tower
929 Gessner, Suite 1900.
V7 combinad.o Houston, Texas 77024
02/12 Para mds informaci6n visita www.cemexusa.com.
a c IU m'u Pa,Jc,�
r
57502480
Plant:
Begin Loading:_
To Job:'-
Arrive Job:
Start Unload:
Finish Unload
Leave:Job`" ;`,
Return Plant::.:
921` 1`,�
t
Customer Code:
Customer Name:
Customer Job Number:
O er Code / Date: `
f {t i
YE�I�t SHELL CONTRACTORS
• I
INC,
�Prdject
c1S
Code:
Project Name:
�,/�o��ytProject
P.O. Numbef:def
P:Oumber.
t'O:
Ticket Date:
Delivery Address:
Map Page: Map/Row/Column:
t2/ _�i 1 5
'3330'0 N All
•2riY.l �. l�c �c:7c' �t3 si3Delivery
Instructions:
Dispatcher:
LMAR , REUD
S.'- I R1 - U C.1 NEC
1
Ticket'Number:
{
k
f4�
Due On Job:
Slump:
Truck Number:
Driver Number:
Driver Name:
End Use:
5
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ol. �:�3 Ft}D
C LEMAN
BLi�Y�{r. d WALL
LOAD CUMULATIVE ORDERED UANTITY QUANTITY QUANTITY MATERIAL CODE PRODUCTION DESCRIPTION UOM UNIT PRICE . AMOUNT ,
Q
�a_ �_ic► :e s"!c .7fi ��: uf.7f.> ; CiY1C YF)3 ;
I iR4 r7,r31 8 F:UEI:.. UR#.: HAI•• BF
12tE271�9 ENVIROMMIENTAL CMARG-E
fi. o l;�ta
J Cash _ Check # / Auth Code: Signature of Driver
] Check
Charge
Comments:
Cash Received:
Total COD Order Amount to Collect
Without Standby Charges:
WATERADDED: COAL YARDS IN DRUM:
�` WHEN ADDED.
RECEIVED M"R 1,3 NIS
SIGNATURE
CURB LINE CROSSED AT OWNER'S/AGENT'S REQUEST:
ONC,gETE DISPOSAL FEE. =
SIGNATURE
PARTIAL FULL. LOAD YARDS
❑ 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.
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
68UNIVERSAL PRE.t,I TRK a INVOICE LOAD NUN: 1
This Delivery Ticket incorporates herein by reference Buyer's previously executed Credit Application, if any, Seller's Standard
Terms and Conditions, Seller's Quotatior iny, and Seller's Order Confirmation (in( ng limitations of warranties), as if fully
set forth on this Delivery Ticket ("Agreen '). Seller will provide the Standard Term. __..1 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 anunonia 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. Hennann Tower
929 Gessner, Suite 1900
V7 combined Houston, Texas 77024
02/12 For more information please visit www,cemexusa.com.
Este ticket de entrega i.ncluye como referencia al comprador (ya previamente ejecutada en su aplicaclj6 de cr6d.ito); cualquier
termino estandar, condiciones del vendedor, propuestas del vendedor y orden de confirmaci6n del vendedor (con limitaciones y
garantias), 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 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 ident.i-
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 albaflilerfa, 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 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 pie] y ojos, y
reacciones alergicas en la piel. Concreto seco y polvo de agregados, pueden causar irritaci6n en los ojos, pie] 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 pul.monar 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 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 la pie]. Use guantes.'protecci6n en los ojos y ropa
Primeros adecuada para proteccion. Ldvese las 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, 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 atenci6n medica inmediatamente si la irritaci6n continua.
CEMEX, Memorial Hermann Tower
929 Gessner, Suite 1.900
V7 combinado Houston, Texas 77024
02/12 Para mas informacion visita www.cemexusa.com.
'IS ail II','kiLd.,I
1142 Water Tower Road, Lake Park FL 33403
Office: 1-877-484-9994 / Fax: 561-844-7102
South East Florida Division Dispatch: 561-844-9994 / Central Florida Division Dispatch: 407-339-5311
Concrete Tested ❑ Yes L];No LOT #
Water Added at Customer's
Cylinders Taken ❑ Yes n No
Request
gals. to full load
Comments
gals. to 2/3 load
gals. to 1/3 load
I
V
4Zo tg 6;,'s je Pb-IWdt6r Added
NOT RESPONSIBLE FOR
WARNING IRRITATION TO THE SKIN AND EYES
ADDITIONAL WATER ADDED TO THIS
VARIATION IN COLOR OR
Cement polymer or freshly mixed concrete may cause skin injury. Avoid contact with
skin and wash exposed skin areas promptly with water. If any cement powder or
CONCRETE WILL REDUCE ITS STRENGTH
SURFACE DISCOLORATION
mixture gets into eyes, rinse immediately and repeatedly with water and get prompt
medical attention. Keep children away from cement powder and all freshly mixed
AND DURABILITY. ANY WATER ADDED IS
AT CUSTOMER'S OWN RISK.
BATCH'TIME
cement products.
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fi
s,��`y
PLANT
TICKET# ORDER
#
TRUCK #
LOAD SIZE
MIX SLUMP
DATE
CUSTOMER #
SOLOTO
P.O. #
PROJECT#
DELIVERY ADDRESS
ZONE#
USE
DRIVER
INSTRUCTIONS
TIME DUE
•
• ' •.1.011
PRODUCTDESCRIPTIO N
U.O.M.AMOUNT
,it.•
'j�,
',S,i 1.�;�.1
C,�I i I i �. ,I�-1. ( r r
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18 015
IRECOVED
SIGNATURE
OR RECEIPT'- CONCRETE
AND ACKNOWLEDGEMENT
OF HAZARD
WAR ING. ; I
asc meyer Concrete Company wi ' no assure la i or any property damage or any SUB -TOTAL
equipment damage for any deliveri4ps beyrond the curb:I e.
�l_
�.=
I � TAX
+� U7HORIZED BY
SHIPMENT SUBJECT TO CONDITIONS ON REVERSE SIDE. TOTAL
THIS DEOV IS MADE SUBJECT TO THE FOLLOW 'ONNT;ONS-
Gijf--Iorr.pr agrecs to provide a suitable roadway for our trucks from the street pavernevt to the place of deiivery
it suui :-zuitabie noadwaygare not proVdad, vm reserve the right to Mop deliveries until condifior�, are iernedied ani, silcin
c-5nl, cuslko!"Yii-, r wifil be held responsible for any loss caused theieby
'Curb line at the customer or customer represpmahva's recloost, any darivqg��.,s V"Pip:m deflvrz�ry is rnade boyond th
1-)u', ', tok lirnited tie, sidevva;ks, driveways, buildings, trees, shrubbery, sept'c tan." and septic systerfis !hE;
field, are at 11he owner's rjsk.
21. customer agrees to reirnbursE said Company for loss of time and equiprneril tjy reas-om of such delivery, and, aisn tc
0
in,-',crrinity and save harmless said Company from any and all claims, demands and suits for or on accourl", of G' Wany
.Fiianner caused by or arising from private driveway delivery.
4 CustcTe( acknowledges that all material and services shown have been received,'that, trucklirnes shwin are c;,,~vzact,
V.,a*ltie amount of water added at the customer's request is shcwn correctly. CAUTION: The addidon of wmfr mdl,�res
concrate strength and durability.
We Eire riot resporisible for finished results obtained from, this load of concrete; many import- .i' tktors Aeciing the u9t3 -nate
upafl,,�,,y of the completed ik)b are beyond'Our scope of responsibility and cont?V.
A c;, , i �Tle �s, axceeded.
,e of $1,00 per will lae charged after 8 ry-tinuresper rubic yard uI lorldl
7c c, js?rner agrees to provide a suitable wash down f acility for our trucics and tools at into p!a!--e cf cielivery r ial
8, Tix; customer hereby agrees to pay at costs and expenses of collection, jrzljding a roascnable attorneys he shall
I ai to pay for tho merchandise reflected in this invoice, when due: Past due ar--counts are subject to a 1 so vice
charge f,)n the unpaid.pa-,q due balance, The custorner hereby acknowledges receipt of the complete cop!) ofthis--Ontract.
>a
J1
11.42 Water Tower Road, Lake Park FL 33403
Eui i�i '� .fllk JI IP�itl Fi���{�j� Kin 2
d! �!`:! flu �"IylliL11Ei' i,i"M Iflllui
!S` mWAlII Ob
Office:1-877-484-9994 / Fax:561-844-7102
South East Florida Division Dispatch:' 561-844-9994 / Central Florida Division Dispatch: 407-339-5311 Call 1nJr
Concrete Tested ❑ Yes '❑ No LOT #
Water Added at Customer's
Cylinders Taken ❑ Yes 0`No
`• Request
gals, to full load
Comments
t
gals. to 2/3 load
gals. to 1 /3 load
>
Customer's Rep - Water Added
NOT RESPONSIBLE FOR
WARNING' IRRITATION TO THE SKIN AND EYES
ADDITIONAL WATER ADDED TO THIS
VARIATION IN. COLOR OR
Cement polymer or freshly mixed concrete may cause skin injury. Avoid contact with
SURFACE' DISCOLORATION
skin and wash exposed skin areas promptly with water: If any cement powder or
CONCRETE WILL REDUCE ITS STRENGTH
mixture gets into eyes, rinse immediately and repeatedly with water and get prompt
medical attention. Keep children away from cement powder and all freshly mixed
AND DURABILITY. ANY WATER ADDED IS
AT CUSTOMER'S OWN RISK.
BATCH TIME
t a
cement products.
Load To Job
t r t
PLANT
TICKET# ORDER',#
TRUCK#
LOAD SIZE
MIX
SLUMP
DATE
f i„
1",i' : � P
L.I lJJ
♦ 5
i-I''r'.. ' 1.•�
' ,'I
_if'� i'�!' 1 h �
CUSTOMER #
SOLDTO
P.O. #
PROJECT#
` ,"_i
11— f1"'1 1 10 '• I :..5 .. ."z-. T!%,!i
� F. f,_
DELIVERY ADDRESS
ZONE#
USE
DRIVER
-J..''I'Al'' i e I, iJd � I l J - i.,1. 1'!P'�'.
� !-1 I }'I J i-
.'i •., ir'
! l .. J.
INSTRUCTIONS
TIME DUE
PRODUCT DESCRIPTION
11111,11119 Its
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irra`yr_is;i'_ %e
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= F,\PY 1,, .„ ^?111; :+_.i•,4
SIGNATURE
OR RECEIPT - CONCRETE
AND ACKNOWLEDGEMENT
OF HAZARD
WARNING'
asc meyer oncrete Company wl not 1sume la 1 I or any property damage or any SUB -TOTAL
equipment damage for any deliveries bey thM_ ine.
`
f�/i 1/1 TAX
AUTHORIZED BY —
SHIPMENT SUBJECT TO CONDITIONS ON REVERSE SIDE. i TOTAL
'THIS DELIV 'IS MADE SUBJECT TO THE FOLLOW '10NWVONS
Customer agrpos to provide a suitable roadwayfor our truck8 from the street pavement to the p%ce of de!ivery ofnial.,trial,
I f such suitable, roadways are 66t provide'd, we reserve the right to stop deliveries until conditions are rernedieland. in such
avert, custorner will be held responsible for any loss caused thereby.
2. Whan delivery is made beyond the curb line at the customer or customer representative's request any damaqk�o
b)ut not limited to, sidewalks, driveways, buildings, trees, shrubbery, septic tanks and septic systerns, including t'ie drair.
f feld, are at the owner's risk.
3. The customer agrees to reimburse sqidCornpany for lossof time and equipment by reason, of such delivery, and a�so to
indemnify and save: harmless said Company from any and all claims, demands and suits for car on account of o;i,'3.71"
mar.rver caused by or arising from private driveway delNery
4. Customer acknowledges that all material and services shown have been received, that truck, tires shovin are corrsQt, and
that the amoont of water added at the customer's request is shown on- rrectly. CAUTION: The addition of water Et�,=,es
concrete strength and durability,
kNe Laro not responsible forfinished results obtained from this load of concrete; mainy it factors affact;nc:l O,T'Ynav�)
qURRty of the completed job are beyond Our Scope of responsibility and control.
6. A charge of $1.00 per minute will be charged after 8 minutes per cubic yard unloading time is exPeded,
7. The cus'orner agrees to provide a Suitable wash down fa614 for our trucks and tools at the Mace of delherr o�, ri,-*Yletial,
8. The customer hereby agrees to pay all costs and expenses of collection, including a reasonable attorneys fes If he steal;
fail to pay for the merchandise reflected in this invoice, when due: Past due accounts are subject to a 1 -1;2c/,,srvics
charge on the unpaid past due balance. The custorner hereby ackrowledges receipt of the complete copy of this contrac',,