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Plant:
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To Job:
Arrive Job:
Start Unload:
finish Unload:
Leave Job:
Return Plant:
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Customer Code: Customer Name:
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Project Code: Project Name:
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Ticket Date: Delivery Address:
Delivery Instructions:
Customer Job Number:
Project P.O. Number.
Order Code"/ Date:
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
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,:
r� SIGNATURE
Pfi t,7 T r-IL. ❑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 andlor 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 '?{=; (,l �� s'. _ r"r{. , '`;+INVOICE
is Delivery 'Ticket incorporates herein by reference Buyer's previously executed Credit Application, if any, Seller's Standard
Fpa
nns and. Conditions• Seller's t,�uotati any, and Seller's Order Confirmation ( ling limitations cal.' warranties), as if fully
forth can this Delivery Ticket (`'Afire _____t"). Seller will provide the StandardTer id Conditions upon request. Buyeragrees
unless otherwise noted on the front hereol', all quantities and iterns� `here delivered as indicated and furtherexpressly agrees to
y in accordance withthe 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. C:'eincnt 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 cernent arid/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, shirt, and/or respiratory tract. Dust from handling,
crushing, grinding, cutting and/or drilling may contain silica, wh.iclt 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 cart cause the ammonia to be released. Inhalation of ammonia can cause coughing and irritation
or bt:rns 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. Avoidbreathing dust. :If' exposed to
dust above reconliriendcd limits (see .MS:DS), wear suitable NI:OSI1-approved. respiratory protection.
First Aid.: In case of eye contact, irml7eChLite ly flush eyes with flowing water for 1.5 minutes. If dust is inhaled, move to fresh
air. 11' wet cement contacts skin, rinse thorouglily with water. Get proper medical attention if irritation persists.
CEM1::X. Memorial Hermann Tower
929 Gessner, Suite 1900
V7 combined Houston, Texas 77024
02/12 For more information please visit www.cenlexusa.coin.
Este ticket de entrega incluye coma referencia at coinprador (ya previamente ejecutada en su aplicaci6ri de cr6dito); cualquier
t rmino est indar, condiciones del vendedor, propuestas del vendedor y orden de confirmac.i6n del vendedor (con limitaciones y
garantfas), corno acuerdo total del ticket de entrega ("Contrato"). El vendedor proveera los terminos estandares y condiciones detal-
lados on caso de asf ser rcqucridos. Con este documento, el coinprador acepta los mismos ya antes menc.ionados y que las cantidades
y materiales fueron entre.gados corno se expresa en el Inismo. Acepta pagar el monto de acuerdo at contrato; at menos que se identi-
fique con una nota al frente de este documento.
AGREGADOS / (:EMENTO / PRODUCTOS DE CONCRETO / CENIZAS VOLANTES
Los productos de agregados son rnateriales naturales Como piedra caliza, dollomita, granito, coca vol.c inica, arena, Drava y otros
rnateriales silicios. Los productos de cernento incluyen Cernerito do tipo Portland, de albanilerfa, pozzolan (tipo IP), azulejo de
azotea. y estuco. l..'os productos de concreto illCltlyeil cernento Portland y productos de agregados Como piedra caliza, dolomita,
granito, roca volcanica, arena, Brava, y otros rnateriales silicios. Estos productos inc.luyen cenizas volantes (fly ash) la cual puede
contener mas de 0.0251% do silicio cristalino.
Peligros: Mezcla de cemento fresco y/o cenizas volantes pueden causar irritaci6n en los Ojos, quemaduras en piel y ojos, y
reacciones al6micas en la piel. Concreto seco y polvo de agregados, pueden causar irritaci6n en los Ojos, piel y/o en
]a zona respiratoria. Polvo del manejo en el trituramiento. pulido, Corte y/o perforaci6n puede contener rnateriales
silicos, los cuales pueden causar si.licOs]s pulmonar y cancer si. son .inhalados. En caso de ser ingerid.os, mantenerse
en temperature caliza, reposar y tomar grandes cantidades de aqua. Las cenizas volantes pueden contener amoniaco.
I_a hurnedad puede causar la liberaci6n del amoniaco. La inhalaci6n del amoniaco puede causar toser, irritaci6n o
Se;ur idad: quernaduras en la nariz, garganta y pulmon.es. Acudir• .inmediatamente a] medico. El..riesgo en la salad depende en
la durac.i6n y el ilivel de la exposici6n.
Seguridad: Evite el contacto con ojos y contacto pro.longado con la piel. Use guantes, protecci6n en los ojos y ropa
Primeros , ad.ecti.ada para p.rotecci6n. Lavese ]as manor con jabon suave y agua despues del mariejo de rnateriales. Evite inha.lar
auxilios• polvos. Si se expone a polvos mas de los limiter recomendados, use protecci6n respiratoria.
Primeros auxilios::En caso de contacto en los ojos, inmmediatamente ffuya ague en la parte afectada por 15 minutos.
Si se inhala polvo, exp6ngase a wire fresco. Si el cemento fresco tiene contacto con sus ojos, lavel.os a fondo con
agua. Acuda a atenci6n m6dica inmediatamente si la irritaci6n continlia.
CEM:EX, Memorial Hermann Tower
929 G'essner, Suite 1900
V7 combinado Houston, Texas 77024
02/12 Para mas informaci6n visita www.cemextisa.com.