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Plant:
Begin Loading:
To Job:
Arrive. Job:
Start Unload:
Finish Unload:
Leave Job:
Return Plant:
Customer Code: Customer Name:
Project Code: Project Name:
Ticket Date: Delivery Address:
Delivery Instructions:
Customer Job Number: Order Code / Date:
Project P.O. Number: Order P.O. Number:
Map Page: Map/Row/Column:
Dispatcher:
Ticket Number:
Due On Job:
Slump:
Truck Number:
Driver Number:
Driver Name:
End Use:
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LOAD CUMULATIVE ORDERED MATERIAL CODE PRODUCTION DESCRIPTION UOM UNIT PRICE AMOUNT
QUANTITY QUANTITY QUANTITY
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Cash Check # /Auth Code: Signature of Driver Receiving Cash; Cash Received: Total COD Order Amount to Collect
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Without Standby Charges:
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Comments:
WATER
ECEIVED i"i, 2 9 7011
GAL YARDS IN DRUM:
WHEN ADDED.
R SIGNATURE
CURB LIVE CROSSED AT-OWNER'S/AGENT'S REQUEST:
SIGNATURE
❑ LOAD WAS TESTED`? BY:
Notice: Our drivers will make every effort to place material'here�t661"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 prppertytline. 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 youurrafety_an�kealth PJease,refer to the backside of this ticket for important
control after delivery, this Company will not accept any responsibility for the fir isF ed results. No credit for safety handling i, formationthematerial
, and to thaterial 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.
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68UNIVERSAL ::: INVOICE ��
This Delivery Ticket incorporates herei reference Buyer's pn,viously executed lit Application, if any, Seller's Standard
Terms and Conditions, Seller's Quotatic,.., .. any, and Seller's Ordor Confirmation (i►.. -Jing 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 ngted on the front hereof, all quantities and items wl .=delivered as indicated and further expressly agrees to
pay in accordance with:th6Agreement.
AGGREGATE / CEMENT / COTSWRETE 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 kcement. masonry,- ozzolan (Type IP), roof tile, and stucco. Concrete
products include Portland cement and aggregate products including limest ndolomite, granite, volcanic rock, sand, gravel, and
other siliceous materials. These products, including fly' sh, may contain 1111;e, than 0.025%o crystalline silica.
Hazards• Freshly mixed wet cement and/or fly ash can cause 4e 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.
ll' ingsted, keep warm, at rest, and drink la:'ge 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 bunts of the nose, throat and lungs. See physician. Health risk depends on duration and level of exposure.
Safety: Avoid contact wit,z eyes and prolonged contact with skin. Wear gloves, eye protection, and appropriate protective
clothing. Wasly 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 Aids In case of eye contact, immediately flush eyes with flowinU water l'or 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
021/12 For more information please visit www.cemext►sa.corn.
Este ticket de entrega incluye co►no referencia al comprador (ya previarnente ejecutada en su aplicaci6n de cr6dito); cualquier
termino estandar, condiciones del vendedor, propuestas del vendedor y orden de confirmaci6n del vendedor (con limitaciorres y
(Yarantfas), Como acuerdo total del `ticket de entrega ("Contrato")'. El vendedor proveera los terrninos estandares y condiciones decal=
lados en caso de asf ser requeridos:,Cein este documento, el comprador acepta Jos mismos ya antes mencionados y que las cantidades
y materiales fueron entregados, come se expresa en el mist -no. Acepta pagar el rnonto de acuerdo al contrato; al menos que se identi-
fique con una nota al frente de este documento.
AGREGADOS / CEMENTO / PROVU.UTO5 DE UONU KE'l'U / UL' 1V1LAN VULAIV'I'hN
Los productos de agregados son materiales naturales Como piedra caliza, dolomita, gran.ito, coca volcanica, arena, grava y otros
materiales silicios. Los productos do Cemento inciuyen Cemento de tipo Portland, de albanileria, pozzolan (tipo IP), azulejo de
azotea y estuco. Los productos de concreto incluyerf Cemento Portland y: productos. de agregados Como piedra caliza, dolomita,
granito, rota volcanica, arena, grava;.y otros materiales silicios..Estos productos inciuyen 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 Jos ojos, quemaduras en piel y ojos, y.
reacciones alergicas,en ]a piel. Concreto seco y'polvo de agregados, pueden causar i►•ritaci6n en los ojos, piel y/o en
la zona respiratoria. Polvo del rnanejo en el tritnrarriiento, pulido, Corte y/o perforaci6n puede contener materiales
silicas, los cuales pueden causar silicosis pulrr onar y cancer si son inhalados. En caso de ser ingeridos, mamenerse
en temperature edlida, reposar y tomar grandes cantidades de agua. Las cenizas volantes pueden contener amoniaco.
I a.humedad puede causar la liberaci6n del amoniaco. La inhalaci6n del amoniaco puede�causar toner, irritaci6n o
Seguridad: quemaduras en to nariz, garganta y puhnones. 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'6 i la piel.'tise gulr46s-; protecci6n en los ojos y ropa
Primeros adecuada para prQtecci6n. Lavese las manos con jab6n suave y agua despu6s del rnanejo de rnatetiales. Evrte inhalar
auxilios• polvos. Si se ckpon& a'pblvos rnas de los limites recomendados, use protection respiratoria.
Primeros auxilios: En caso de contacto en los ojos, inmediatamente fluya agua en la parte afectada por 15 minutos.
Si se •rnhala polvo,. exp6n asea afire fresco. Si el Cemento fresco ticue contacto con sus ojos, lavelos a Tondo con
agua. Acuda a atenci6n mddica inmediatamente si la irritaci6n continua.
CEMEX, Memorial Hermann Tower
929 Gessner, Suite 1900
V7 combinado -Houston, Texas 77024
/12 Para mas infoimaci6n visita www.cemexusa.com.