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Sf'. Lucie County' Permitting
Plant:
Begin Loading:
To Job:
Arrive Job:
Start Unload: Finish Unload:
Leave Job:
Return Plant:
Customer Code:
Customer Name:
Customer Job Number: Order Code / Date:
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Project Code:
Project Name:
Project P.O. Number: Order P.O. Number:
Ticket Date:
Delivery Address:
Map Page: Map/Row/Column:
Delivery Instructions:
Dispatcher:
/
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Ticket Number.
Due On Job:
Slump:
Truck Number:
Driver Number:
Driver Name:
End Use:
LOAD CUMULATIVE I ORDERED I 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
Without Standby Charges:
Check
Charge
Comments:
WATERADDED: GAL YARDS IN DRUM:
WHEN ADDED.
CURB LINE CROSSED AT OWNER'S/AGENT'S REQUEST:
SIGNATURE
J 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 materialsafety 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 INVOICE
This Delivery Ticket incorporates herein by reference Buyer's previously exec-1-4 Credit Application, if any, Seller's Standard
Terms and Conditions, Seller's Qu( )n, if any,' nd Seller's Order Confinnati nctuding limitations of warranties), as if fully
set forth on this Delivery Ticket (" Aa_ _intent"). Seller will provide the Standard i erms and Conditions upon request. Buyer agrees
that, unless otherwise noted on the front hereof, all,tluantities and items were delivered as indicated and further expressly agrees to
pay in accordance with the Agreement. i
AGGREGATE / CEM.ENVCONCRETE 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 lim ;stone, dolomite, granite, volcanic rock, sand, gravel, and
other siliceous materials. These products, including fly ash, may contain more than 0.025%o 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 warn, at rest, and drink'Jarge 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 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 1VIOSH-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.l.If wet cement contacts skin, rinse thoroughly with water. Get proper medical attention if irritation persists.
CEMEX, Memorial Hennann Tower
10100 Katy Freeway, Suite 300
V8 combined Houston, Texas 77043
0.1/17 For more information please visit www.cemexusa.com.
Este ticket de entrega incluye como referencia al. comp.rador (ya previamente ejecutada en su aplicaci.6n de cr6dito); cualquier
t6rmino estandar, condiciones del vendedor, propuestas del vendedor y orden de confirmaci6n del vendedor (con limitaciones y
garantfas), como acuerdo total del ticket de entrega ("Contrato"). El vendedor proveera los tdr•minos 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 contrcto; 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 naturales como piedra caliza, dolomita, granito, coca volc{utica, arena, grava y otros
materiales silicios. Los productos de cemento incluyen Cemento de tipo l?,ortland, de albaflilerfa, pozzolan (tipo 1P), uulejo de
azotea y estuco. Los productos de concreto incluyen cemento Portland y productos de agregados como piedra caliza, dolomita,
granito, coca volcanica, arena, Brava, y otros. materiales sil.icios. Estos productos incluyen cenizas volantes (fly ash) la cual puede
contener mds de 0.025% de silicio cristalino.
Peligros: Mezcla de cemento fresco y/o cenizas volantes pueden causar. irritacion en los ojos, yuemaduras en piel y ojos, y
reacciones a[6rgicas en la piel. Concreto seco y polvo de agregados, pueden causar irritaci611 en Jos 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 pulmonar y cancer si son inhalados. En caso de ser ingericlos, mantenerse
en temperatura cdlida, reposar y tomar grandes,pantidades de agua. Las cenizas volantes pueden contener amoniaco.
Seguridad• La humedad puede causar la liberaci6n del amoniaco. La inhalaci611 del amoniaco puede causar toser, ir•itaci6n o
quemaduras en .la nariz, gargan.ta 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 piel. Use guantes, protecci6n en los ojos y ropa
Primeros adecuada para protecci6n. Lavese las mans con jab6n suave y agua despu6s del manejo de materiales. Evite inhalar
auxilios: polvos. Si se expone a polvos mds de Jos limites recomendados, use protecci6n respiratoria.
P.rimeros auxilios: En caso de contacto en los ojos, inmediatamente fluya agua en la parte afectada por .1.5 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 irritaci611 continua.
CEMEX, Memorial. Hermann Tower
10100 Katy Freeway, Suite 300
V8 combinado Houston, Texas 77043
01/17 Para mas informati6n visita www.ceinexusa.com.