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Plant: Begin Loading: To Job:: Arrive Job: Start Unload: Finish Unload: Leave Job: Return Plant:
01-901i 1090
Customer Code: Customer Name: Customer Job Number. Order Code / Date:. _
111�11:t OAK HAMMOCK CONSTRUCTION INC 2a�,__871.I 211. 12/05/13
Project Code: Project Name: Project P.O. Number. ^ ' bOeirder Pp0. Number. t
Ticket Date: Delery Addressr lapPage: Ma IRow Colurtlp:
1.i_:/I:�5/ 1 r r,527 PERIMETERRD r_is5� y1 1
Delivery Instructions: Despatcher:
-FII..t+l CI l"'Y !...•:�.' € UII.D, TO 133,EC `ER ROAD F�.�.�;�},"i �sl �cttiinr�
10 0-1 L.El lc ONTO t:i I I —SON ROADA R l; t. HT T tRP.1AD TOUT.
:. Ticket Number.
32905203
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LOAD
QUANTITY
CUMULATIVE
QUANTITY
ORDERED
QUANTITY
MATERIAL CODE
PRODUCTION DESCRIPTION
UOM
UNIT PRICE
AMOUNT
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1C?n 01.
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3000 BLE_NDE1.1PRP11I
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Cash Check # / Auth Code:
Check
Charge
Comments:
+
1247818 FUEL SURCHARGE
3.202749 ENVIRONMENTAL. Cl-DIRGE
of Driver Receiving Cash: Cash Received: Total COD Order Amount to Collect
Without Standby Charges:
WATER ADDED,' � GAL YARDS IN DRUM (Z - [/
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 materia s where the customer designates, but the SPECIAL TERMS: Any wat r 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. RNING: Pry ct 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 he(fa to yo r safety a 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 creditfor, safety h�n ling 'nformption, and to a material safety data sheets for additional information.
returned concrete. Buyers exceptions and claims shall be deemed waived unless made to us in writing UTHO IZED IGNAT E:
within one business day after the receipt of materials. O
PREY TC K o LOAD NUM: 1
68UNIVERSAL
INVOICE
1 nis Delivery .11cKet incorporates herein by reterence Buyers previously executed Credit Application, if any, Seller's Standard
Terms and Conditions, Seller's Quotation. ny, and Seller's Order Confirmation limitations of warranties), as if fully
set forth on this Delivery Ticket ("Agreem ). Seller will provide the Standard Terms 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 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.
CEINAEX, Memorial Hermann Tower
929 Gessner, Suite 1900
V7 combined Houston. Texas 77024
02/12 For more information please visit www.ceTnexusa.com.
Este ticket de entrega incluye coma referencia al comprador (ya previamente ejecutada en su aplicaci6n de credito); cualquie.r
termino estandar, condiciones del vendedor, propuestas del vendedor y orden de confirmaci6n del vendedor (con limitaciones y
garant.fas), como acuerdo total del ticket de entrega ("Contrato"). El vendedor proveera los terminos estandares y condiciones detal-
lados en caso de asf ser requeridos. Con este documento, el comprador acepta los lnismos ya antes mencionados y que las cantidades
y materiales fueron entregados como se expresa on el nusmo. Acepta pagar el monto de acuerdo at contaato; at menos que se identi-
fique con una rota a] frente de este documento.
AGREGADOS / CEMENTO / PRODUCTOS DE CONCRETO / CENIZAS VOLANTES
Los productos de agregados son materiales naturaley como piedra caliza, dolomita, granito, coca volcanica, arena, grava y otros
materiales silicios. Los productos de cemento incluyen Cemento de tipo Portland, de alban"ilerfa, 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 piel y ojos, y
reacciones alergicas en la pie]. Concreto seco y polvo de agregados, pueden causar irritaci6n en los ojos, pie]. y/o en
la zona respiratoria. Polvo del manejo on el trituramiento, pulido, cone y/o perforaci6n puede contener materiales
d silicos, los cuales pueden causar silicosis pulmonar 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 arnoniaco.
Seguridad• La humedad pued.e causar la li.berac6n del amoniaco. La inhalaci6n del amoni.aco puede causar toser, irritaci6n o
quemaduras en la nariz, garganta y pulmones. Acudir inmediatamente at 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 protecci6n. Lavese 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 protecci611 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 Tondo con
agua. Acuda a atenci6n medica inmediatamente si la irritaci611 continda.
CEMEX, Memorial Hermann ,rower
929 Gessner, Suite 1900
V7 combinado Houston, Texas 77024
02/12 Para mas inforlrlaci6n visita www.cemexusa.com.