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Materials for Life`
gr&Acreteo
cc-1)(7�
"Thank you - We appreciate your business"
ISCANINW3 FOPT PIERCE
19
9 SI"LVITZ ROAD
irT l>f ,T PIERCE, FL 34982
82906
Delivery date Plant Truck Driver Truck size Type job
Q /O1 / a E to 13 0 GIL,CHRIST, �Ct�EfaOr�° � a P)CELL F3
no.
Customer name
Zone
Tax CD
ICustomer
5'00027 7
I SHELL SUBCONTRACTORS INC
` a
Tarmac project no.
Customer P.O. no.
Order no.
Terms code Char a delivered 3-C.O:D.
Time due
I _I`q C 7oa
I
9109
I ' Large
7c eJ <
2-Charge F.O.B. 4-C.O.D -F.O.B.
Delivery name and adddre�sss COUNTY
Block
County
1.24 OLIEEN , AN14 CT, FART PIERCE
Instructions L1Ur,J�-.4;Y - n 4,.,U V _ . Uzi t i� .C�,UF-FV, J.:3 to vJI-, --li 4l.Jtl.LtJ'.ia H_'.(•�d iv, ! C L.
Slump
REGAL Rj?, COMTIMUE O QUEENS RD, T /L SOVEREIGN WAY, T/L
3e Ore
QUEEN ANN CT
Quantity ]Product
Ui!
Unit price (Amount
-
Load
Cumulative
Ordered
Code
Description
1.
0/ 0
1.00 1
00 CA-
B3P104.0OC: `8 PSI
CY
1. A
00
80C
007 :FUEL SURCHIS
LD
1.
00
840c,
01 14 ENVIR01111 SURCHG
LD
1.00
80C,
D3?3 SHORT LOAD
T ,;
1
Load
Arrive job site
Start discharge
Finish discharge
Leave job site
Arrive plant
0
Subtotal
Sales tax
-
TOTAL
Additional water added to this concrete will reduce its strength. Any water added is at customer's risk.
Gallons of water added: %Y% Gallons of water added: J Gallons of water added: Amt of CY Retained:
c
Customer Approval: Customer Approval: Customer Approval: Customer Approval
Tested Tested properly No, ,r, -_- Authorized.anld'r ceived by
❑ Yes Q No ❑ Yes ' ❑ No X
Lot:
Safety is a constant state of mind, with
every employee feeling responsible Block:
and empowered to act to cause him Address: correct Not correct
and others to work safely, on the belief
that all accidents are preventable and
that zero incidents is the only goal.
/ 1 1/1T •1 % f
RECER" T FEB 2 4 201
r
1142 Water Tower Road, Lake Park FL 33403
Office:1-877-484-9994 / Fax:561-844-7102
South East Florida Division Dispatch: 561-844-9994 / Central Florida Division Dispatch: 407-339-5311
fq'�;i ! �I ;j °'J f '
j
iil'`j', 711111 iIL_
Concrete Tested ❑ Yes ❑ No LOT #
Cylinders Taken 0 Yes ❑ No
Requee t -
f '4 gals. to full load.
Comments
gals, to 2/3 load
gals. to 1/3 load
Customer'§ Rep - Water Added
NOT RESPONSIBLE FOR
WARNING IRRITATIONTO THE SKIN AND EYES
ADDITIONAL WATER ADDED TO THIS
VARIATION IN COLOR OR
Cement polymer or freshly mixed concrete may cause skin injury: Avoid contact with
CONCRETE WILL REDUCE ITS STRENGTH
SURFACE DISCOLORATION
skin and wash exposed skin areas promptly with water. If any cement powder or
mixture gets into eyes, rinse immediately and repeatedly with water and get prompt
medical attention. Keep children away from cement powder and all, freshly mixed
AND DURABILITY. ANY WATER ADDED 1S
AT CUSTOMER'S OWN RISK.
BATCH TIME
cement products.
T Job
On Job
Begin Pour
ON N Fril
771
TICKET#
ORDER #
TRUCK #
LOAD SIZE
MIX SLUMP
DATE
...-, ,_����y-.'qr
1
CUSTOMER #
SOLD TO
P.O. #
PROJECT#
DELIVERY ADDRESS
ZONE#
USE
DRIVER
I.ff T.
INSTRUCTIONS TIME DUE
CUMULATIVE
ORDERED
PRODUCT CODE
PRODUCT DESCRIPTION
U.O.M.
UNIT PRICE
AMOUNT
QUANTITY
QUANTITY
_T' V " ,J
SIGNATURE
OR RECEIPT - CONCRETE
AND -ACKNOWLEDGEMENT
OF HAZARD
WARNING
• asc eye.r "oncr . e ompany will not assume liability for any property damage or any
SUB -TOTAL
;equiQm nt^damage for"any deliveriess;'beyond the curb line.
,+try- 1 �>> �J•
TAX
AUTHORIZED BY
TOTAL
tIIPMENT SUBJECT TO CONDITIONS ON REVERSE SIDE.