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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:
••• i - - r ;'1
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 QUANTITY QUANTITY QUANTITY PRODUCTION DESCRIPTION UOM UNIT PRICE AMOUNT
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:
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 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 lrr" '1' f ' '�
i
68UNIVERSAL r�' 1 1' • : „ : !L:;'i
INVOICE
This Delivery Ticket incorporates herein by reference Buyer's previously executed Credit Application, if any, Seller's Standard
Terrns and. Conditions, Seller's.Quot. - r, if any, and Seller's Order Confirmatiot eluding limitations of warranties), as if fully
set forth on this :Delivery '1 icket ("A�, nent"). Seller will provide the Standard 'I s and Conditions upon request. Buyer a�; ces
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, rn:isonr•y, 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 and/or fly ash can cause eye irritation, skin and eye burns and. allergic skin reactions.
Dry concrete and aggregate (lust may cause irritation to eyes, slain, and/or respiratory tract. Dust from handling,
crushing, grinding. cutting; and/or drilling may contain silica, which may cause silicosis and cancer. if inhaled.
11" ingested, keep warm, at rest, and drink large amounts of water. -Fly Ash may contain trace amounts of ammo-
nia. :Moisture can cause tite 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.
I
Safety: Avoid contact with eyes and p�•olonged contact with skin. Wear gloves, eye protection, and appropriate protective
clothing. Wash hands thoroug0trly with mild soap and water after handling. Avoidbreathing dust. If exposed to
(.List above recommended limits (see MS:DS), wear suitable NI:OSH-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. 11' wet cement contacts skin, rinse thorow;hly with water. Get proper medical attention if irritation persists.
CEME.X, Memorial Hermann Tower
929 Gessner. Suite 1900
V7 combined Houston. Texas 77024
02/12 For more information please visit www.cenrexusa.com.
.Este ticket do entrega inCluyc Como rcferencia al comprador (ya previamente (jecutada en su aplicaci6n de cred.ito); cualquier
termiuo estfurdar, condiciones del vendedor, propuestas del vendedor y orden de confirmac.i6n del vendedor (con .limitaciones y
garantfas), Como acuerdo total (lei ticket de entrcga ("Contrato"). El vendedor proveera los terminus estandares y condiciones detal-
lados en caso de asf ser requcridos. Con cste dOCUrnento, el cornprador acepta los rnismos ya antes mencionados y que .las cantidades
y materiales fueron entrcgados como se expresa en el mismo. Acepta pagar el rnonto de acuerdo al contaato: al menos que se identi-
fique con una nota al freme de este dOCUlnento.
AGREGADOS / CEMENTO / PRODUCTOS DE CONCRETO / CENIZAS VOLANTES
Los productos de agregados son materiales natura.les como piedra caliza, dolomita, granito, roca volc6nica, 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 KnCluyert cernento Portland y productos de agregados como piedra caliza, dolomita,
granito, roca volcanica, arena, Brava, y otroslrirateriales silicios. Estos productos inc.luyen cenizas volantes (fly ash) la cual puede
contener mas de 0.025% de silicio cristal.ino
11'eligros: Mezela de cemento fresco y/o cenizas volantes pueden causar irritaci6n en los ojos, quemadu.ras en piel y ojos, y
reacciones alergicas en la piel. Concreto seco y polvo de agregados, pueden causar irritaci6n en Los ojos, piel y/o en
la zona respiratoria. Polvo del manejo en el trituramiento, pulido, corte y/o perforaci61l puede contener materiales
silicas, los cuales pueden causar silicosis pulmonar y cancer si. son inhalados. En caso de se.r i.ngericlos, mantenerse
en temper atura calida, reposar y to nar grandes cantidades de aqua. Las cenizas volantes' pueden contener amoniaco.
La htrmedad puede causar la liberaci6n del amoniaco. La inhalaci6n del amoniaco puede causar toser, irritaci6n o
Segw idad: quernaduras en la nariz, garganta y pultnones. Acud.ir 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 prolong con la piel. Use guantes, protecci6n en los ojos y ropa
Primeros adecuada para p.rotecei6n. Lavese las menos con jab6n suave y agua despu6s del manejo de materiales. Evite inhalar
auxilios: polvos. Si se expone a polvos mas de los limites recomendados, use protecc16n 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 ]a irritaci6n contin6a.
CE:M:EX, Memorial Hermann Tower
929 Gessner, Suite 1900
V7 combinado Houston, Texas 77024
02/12 Para mas informati6n visita www.cemexusa.com.
Plant:
Be6in Loading'
70,Job:';
Arrive Job:
Start Unload:. ,
Finish Unload ,
° Leabe'Job
Rett m Plarit
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Customer Code: Customer Name:
Customer Job Number:
Order Code / Date:
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Map Page. Map/Row/Column:
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Ticket Number: _.
Due On Job:
Slump:
Truck Number:
Driver Numoer;
Driver'Name:
End Use:
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QUA TITY I CQUANTITYE I QUANTITY I MATERIAL CODE I PRODUCTION DESCRIPTION
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UOM UNIT PRICE AMOUNT
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Cash Check # / Auth Code: Signature of Driver Receiving Cash: Cash Received: Total COD Order Amount to Collect
%, Without Standby Charges:
Check `1 + '
Charge
comments::
WATER ADDED: k' ./� GAL YARDS IN DRUM:
WHEN ADDED.
SIGNATURE
CURB:LINE CROSSED AT OWNERVAGENT'S REQUEST:
ti PART T AL _ FUL L. L 0 A D %/AR`DS 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 curborproperty line. Customer agrees to the is no longer guaranteed. WARNING: Product maycause 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..
68UNIVERSAL
rf F;E- v "f Fki - �t. (;il::S7 sue" {�d C i , � 1.._ 0U1, -!SBE �i F�4`
IN�OICE
LOAD NUIrk
liis Delivery Ticket incorporates herein by reference Buyer's previously executed Credit Application, if any, Seller's Standard
,,,�Terms and Conditions, Seller's Quo1 r, if any, and Seller's Order Confirmatio icluding limitations of warranties), as if fully
set forth on this Delivery Ticket ("Al neat"). Seller will provide th,;Standard Iis and Conditions upon request. Buyer agrees
that, unless otherwise noted on the front hereof, all quantities and item, were' delivered as indicated and further expressly agrees to
pay in accordance with the Agreement.
AGGREGATE / CEMENT / CONCRETE PRODUCT'S / 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.
11' 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 bums 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 N1OSH-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 incluye como referencia al. comprador (ya previamente ejecutada.en su aplicaci6n de cr6dito); cualquier
t6rmino estindar, condiciones del vendedor, propuestas del vendedor y orden de con'firmaci6n del vendedor (con limitations y
garantfas), como acuerdo total del ticket de entrega ("Contrato"). El vendedor proveerl 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 al contacto; al menos que se identi-
fique con una nota al frente de este documento;
AGREGADOS / CEMENTO / PRODUCTOS DE CONCRETO / CENIZAS VOLANTES
Los productos de agregados son materiales naturaley 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 sil.icios. Estos productos incluyen cenizas volantes (fly ash) la coal puede
contener mds de 0.025% de silicio cristalino.
Peligros: Mezela de cemento fresco y/o cenizas volantes pueden causar irritaci6n en los Ojos, quemaduras en pi.el 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'nianejo en el trituramiento, pulido, torte y/o perforaci6n puede contener materiales
silicos, los cuales pueden causar silicosis pulmonar y clrncer s.i 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 pu.lmones. 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 piel. Use guantes, protecci6n en los ojos y ropa
Primeros adecuada para protecci6n. Lavese las menos 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.
CEME�X, Memorial Hermann Tower
929 Gessner, Suite 1900
V7 combinado Houston, Texas 77024
02/12 Para mds informaci6n visita www.cemexusa.com.
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Plant:
'Begin Loading:
To Job:
Arrive Job,
Start Unload:
Finish Unload:
Leave Job:
Return Plant:
;CustbmeCCdd@ 35 '(justornerlName:i)N—q'!RUL".7:j:ili'ti9S{',.RVICES LLC Custom'E3r.;lobN6mber:ot::•Z_)- OrdeiCodelDate: t"}laG,
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IDeh�er�ins�ruchons: !, r > DispatcWrx° t...•%!. d 3
Ticket Number:
Due'On'Job:•t'-' Slump: � q '' Truck Number:•''"' J r Driver Number:^/ Drifter Namer 1 `I %J. End USe: i.'L..lrl41.4
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Cash Check# /Auth Code:
Signature of Driver Receiving Cash:
Cash Received: •
Total COD Order Amount to Collect '
Without Standby Charges:
Check -
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.,
Charge
,•
Comments:
WATER ADDED: �� GAL
YARDS IN DRUM:
WHEN ADDED,
SIGNATURE
CONCRETE FEE
CURB LINE CROSSED AT OWNER'S/AGENT'S REQUEST:
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Notice: Our drivers will make eve effort to lace materials where the customer designates, but the P C E every p g b h S IAL VMS: Any water added is at customers own risk. If water is added on job, conc�te strength
Company assumes no responsibility for damages inside curb or property line. Customer agrees to the is n8 longe glifaranteed. 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 maykbe haz ' ous to your safety and health. Please refer to the backside Lthis ticket for important
control after delivery, this Company will not accept any responsibility for the finished results: No credit for safet�rhanrilir2gtinfolmatioqf and to the atenal safety data sheets for additional information.
returned concrete. Buyers exceptions and claims shall be deemed waived unless made to, us in writing AUTHORIZED IGNAku E:
within one business day after the receipt of materials. O
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1"'I-.�-u' 1 r-�a c _•ti�/"'fur �..-!: w`a., ... +_...1 1 t_I V:.. LLJ r{1J tV4l'e� �,•,
68UNIVERSAL 1 l
L J 'INVOICE
e
This ; Delivery Ticket incorporates heroin by reference .Buyer's previously executed Credit Application, if any, Seller's Standard
Terms and. Conditions. Seller's Qucita if any, and Seller's Order C;onfi..rrrtatiorj lulling limitations of warranties), a! if fully
set forth oil this Delivery Picket ("Agi____.ent"). Seller will provide the Standard Ti---- and Conditions upon request. Buyer agrees
that, unless otherwise rioted,'6n 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 nilturally occurring materials including limestone, do.lornite, granite, volcanic rock, sand, gravel, and other
siliceous materials. Cement products inC;lude Portland cement,, masonry, pozzolan (Type .[P), roof tile, and stucco. Concrete
products include 1'ortlund 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 and/or fly ash can cause eye irritation, skin and eye burns and allergic skin reactions.
Dry concrete and ggregate 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 kings. 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.'respiratoryprotection.
I+'first Aid: Ili 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.
CEME:X. Memorial Hermann 'rower
9219 Gessner, Suite 1900
V7 combined 1-Iouston. 'Texas 77024
t12/12 For more information please visit www.cemexusa.com.
Este ticket de entrega inCluye Como referencia al. con.iprador (ya previamente ejecutada en su apl.icaci6n de cred.ito); cualquier
termino estindar, condiciones del vendedor, propuestas del vendedor y orden de confirm.ac.i6n del vendedor (con .limitaciones y
garantfas), corno a.cuerdo total del ticket de entrega (`•Contrato"). El vendedor proveerd los terminos estandares y condiciones detal-
lad.os on caso de asf ser requeridos. Con este (loqurnento, el comprador acepta los mismos ya antes mencionados y que las canti.dades
ymater•iales fueron entregaclos comp se expresa en el rnismo. Acepta pagan el monto de acuerd.o al contrato: al menos que se identi-
fique con urrrr nota al freme de este docurnento.
AGREGAllI)".) / k:EMElN'UO / VK0VULJ 1)N liL Uu1NUKh'1'0 / 1;1:1NILAN vuLA1N'1'hN
Los productos de agregados son materiales nat.u.rales corno piedra caliza, dolomita, granito, rota vol.cilnica, arena, grava y otros
materiales silicios. Los productos de cemento incluyen Cernento de tipo Portland, de albanilerfa, pozzolan (tipo I.P), azulejo de
azotert y estuco. Los productos de concreto incluyen cemento Portland y productos de agregados como piedra caliza, dolomita,
granito, rota volcanica, arena. Brava, y otros materiales silicios. Estos'pr6ductos .incluyen cenizas volantes (fly ash) la coal puede
contener mas de 0.025c de silicio cristal.ino.
Peligros: Mezcla de c emento fresco y/o cenizas volantes pueden causar irritaci6n en los Ojos, quemaduras en piel y ojos, y
reacciones al&,gicas en la piel. Concre'to seco y polvo-de agregados, pueden causar irritaci.611,en los ojos, piel y/o en
la zona respiratoria. Polvo del manejo en el trituramiento, pulido, torte y/o perforaci6n puede contene.r materiales
siliicos, los cuales pueden causar silicosis puhnonar y cancer si. son .inhalados. En caso do ser ingerid.os, mantenerse
en temperatura calicla, reposar y.toma'r grander cantidades de aqua. Las cenizas volantes pueden contene;r amoniaco.
La hirnrcdad puede causar la liberaci6n del amoniaco. La inhalaci6n del amoniaco puede causar toser, irritaci6n o
Seguridad: quediadur pis -en la nariz, garganta y pulmones. Acudir inmediataniente al medico. El.riesgo en 1a salud. depende en
la duraci6n y el n.ivel de la exposici6n.
Seguridad: Evite el contacto con ojos y contacto prolongado con la piel. Use guantes, protecci.6n en los ojos y ropa
Primeros adecuada'para p.rotecci6n...Lavese las manor con jab6n suave y agua despues del manejo de materiales. Evite .inha.lar
auxilios: polvos. Si se expone a polvos mas de los limiter recomendados, use protecci6n respiratoria.
Primei•os auxilios: En caso de contacto en los ojos, inmediatamente fluya aqua en .la parte afectada por 15 minutos.
Si se inliala polvo, exp6rigase a aire fresco. Si el cemento fresco tiene' contacto con sus ojos, .lavelos a fondo con
amta. ACuda a atencl6n m6dica inmediatamente si la irritaci6n continda.
CEMEX, Memorial Hermann Tower
929 Gessnei', Suite 1900 r
V7 combihado Houston, Texas 77024
02/12 Para mas inforrrlaci6n visita www.cemexusa.com. ��