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Customer Job Number: Order Code /Date:
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a LOAD CUMULATIVE ORDERED I
QUANTITY QUANTITY QUANTITY MATERIAL CODE P RIPTION UOM UNIT PRICE AMOUNT
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';..;`�j Cash. Check #/Auth Code:. .'Signature. of Driver Receiving Cash: Cash Received:. .Total COD Order Amount to Collect
Check Without Standby Charges:
i Charge ,
)' Comments:
+i WATER'ADDED: GAL . YARDS IN DRUM: '
WHEN ADDED.
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i SIGNATURE
CURB LINE CROSSED AT OWNER'S/AGENT'S REQUEST:
' f rtr 3; P , v � l.A l p..:.{.1���` SIGNATURE
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f O"LOAD W(S TES -ED E Y:
Notice: Our drivers will make every effort to place materials where the customer designates, but the S ECIAL TER S: Any water,Aed i at customers own risk. 'If water isadded on job, concrete strength
(!!, Company assumes no responsibility for damages inside curb or property line. Customer agrees > o to the is longer guarapteed. WARNING: lroductmay cause skin and/or eye irritation. CAUTION: Material
- j terms of sale and delivery and accepts concrete as is. Due to important factors which are out of our rn b hazar`dou3,I� your safety an health. Please refer to the backside of this ticket for important
I i control, after delivery, this Company will not accept any responsibilitythe finish ad, results. 'No credit for safety handling: information; and to the nri teriaf safety data sheets for additional information.
j' returned concrete. Buyers exceptions and claims shallbe deemed waived unless made to, us inlwriting AUTHORIZED GNhbTURE
within one business day after the receipt of materials. O \�
68UNIVERSAL `•� i'tf�, v"
l' CUSTOMER 1
This Delivery Ticket incorp Xates herein by reference Buyer's previouslyegxecuted Credit Application, if any, Seller's Standard
Terms and Conditions, Se11eS notation, if any, and Seller's Order Con'" �tion (including limitations of warranties), as if fully
set forth on this Delivery Tic Qv
("Agreement"). Seller will provide .the Stare and Terms and, 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 imitation 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 .imitation
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 tlior ugh) iwrthtmrld p agddwater after handling. Avoid breathing dust. If exposed to
dust above recommndl ltrrnts`'(s�ewMSDB) wear siltable NIOSH-approved respiratory protection.
First Aid: In case of eye contact, rmniediat6lyaflush�p�yes witK,.fldwing water for .15 minutes. If dust is inhaled, move to fresh
air. If wet cement contacts skin,"rinse th6rough13 °s?' h water. Get proper medical attention if irritation persists.
929 Gesner, 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 credito); cualquier
termino estandar, condiciones del vendedor, propuestas-del vendedor y orden de confirmaci6n', del vendedor (con limitaciones y
garantfas), como acuerdo total del ticketide entrega ("Contrato"). El vendedor proveera Jos terminos esfandares y condiciones detal-
lados en caso de asf ser requeridos. Con este documento, el comprador acepta los mismos ya ante, mencionados y que las cantidades
y materiales fueron entregados como se expresa en el mismo. Acepta pagar el monto de acuerdo al contrato; al m.enos que se identi- j
fique con una nota al frente de este documento. J
AGREGADOS / CEMENTO / PRODUCTOS DE CONCRETO / CENIZAS VOLANTES
Los productos de agregados son materiales naturales como piedra caliza, dolomita, granito, roca volednica, arena, grava y otros r '
materiales silicios. Los productos de cemento incluyen Cemento de tipo Portland, de albaiiilerfa, 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.
ICUIDADO!\�
Peligros: Mezcla de cemento fresco y/o cenizas volantes pueden causar irritation en los ojos, quemaduras en piel y ojos, y
reacciones alergicas en la piel. Conereto seco y polvo de agregados, pueden causar imrtaci6n en los Ojos, piel y/o en
la zona respiratoria. Polvo del manejo en el trituramiento, pulido, torte y/o perforaci6n puede contener materiales
silicos, los cua.les pueden causar silicosis pulrnonar y cancer si. son inhalados. En caso de ser ingeridos, mantenerse
en temperatura calida, reposar y tornar 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, irritacibn o t
quemaduras en la nariz, garganta y pulmones. Acudir .inmediatamente al medico. El riesgo en la salud depende en l� f
la durac.i6n y'el nivel de la exposition. (
Seguridad: Evite el contacto con ojos y contacto prolongado con la piel. Use guantes, protecci6n en los Ojos y ropa I
Primeros adecuada para protecc.i6n. Lavese las manor con jab6n suave y agua despues del manejo de materiales. Evite inhalar `
auxilios• polvos. Si se expone a polvos mas de los limiter recomendados, use proteccion respiratorria. I
rimeros auxilios: En caso de contacto en los ojos, inmediatamente fluya agua en la parte afectada por 15 minutos. I
Si se inhala polvo, exp6ngase a a.ire fresco. Si el cemento fresco tiene contacto con sus ojos, .lavelos a fondo con
agua. Acuda a atenci6n medica inmediatamente si la initaci6n continda. I�
CEM.EX, Memorial. Hermann. Tower i
929 Gessner, Suite 1900 �
V7 combinado Houston, Texas 77024
02/12 Para mas informaci6n visita-www.cemexusa com. -
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Plant: Begin Loading: To Job: Arrive Job: Start Unload: Finish Unload: Leave Job: Return Plant:
Customer Code:
Customer Name:
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Ticket Date:
Delivery Address:
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Customer Job Number: Order Code / Date:
Project P.O. Number: I O'rder'P.O. Number`-"
MapYPage: Map/Row/Column:
Dispatchers
Ticket Number:
Due On Job:
Slump:
Truck Number:
Driver Number:
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Driver Name:
End Use:
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LOAD
CUMULATIVE
ORDERED
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:
WATER ADDED: GAL
YARDS IN DRUM:
WHEN ADDED.
I
SIGNATURE
CURB LINE CROSSED AT OWNER'S/AGENT'S REQUEST:
PARTIAL FULL t-.0A,0 � i{i'If�rl,�'1 SIGNATURE
❑ LOAD WAS TESTED BY:•
rr
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 informatiot�, 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.4
68UNIVERSAL PRf:. V i RI'i ;; LOAD NIt.lM . I,
INVOICE
This Delivery Ticket incorporates herein by reference Buyer's previously :uted Credit Application., .if any, Seller's Standard
Terms and Conditions, Seller otat.ion, if any, and Seller's Order Confi on (including limitations of warranties), as if fully
set forth on this Delivery Ticli kgreement"). Seller will provide the Standard 'Perms and Conditions upon request. Buyer agrees
that, unless othe.r�yise. toted ,on ,thefront hereof, all quantities and items were delivered as indicated and further expressly agrees to
pay i.n accordance, ',Witb`th0 Agicern-en' t e 3
.AGGREGATE'( CEMENT / CONCRETE PRODUCTS / FLY ASH
Aggregate products a ye' naturally;c�ccui-ir�ng mate s�l:s including limestone, dolomite, granite, volcanic rock, sand, gravel, and other
siliceous materials Cement product's" includes Portland cement, masonry, pozzolan (Type IP), roof tile, and stucco. Concrete
products include >�'vrtlar ce.meT ti �[rirl°aggreg to p.Toducts including limestone, dolomite, granite, volcanic rock, sand, gravel, and
other siliceous matei•ialk These products, inc;l idju'g 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 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.
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 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 Hermann Tower
929 Gessner, Suite 1900
V7 combined Houston, Texas 77024
02/12 For more information please visit w w.cemexusac�n.
Este ticket de entrega incluye como referencia al comprador (ya previamente ejecutada en su aplicacion de,crEdito); cualquier
termino estandar, condiciones del vendedor, propuestas del vendedor y orden de confirmation del vendedor (con limitaciones y
garant.fas), como acuerdo total del ticket de entrega ("Contrato"). El vendedor proveera los terminos estaildares 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 contaato; 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, roca 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. L,os 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) ]a cual puede
contener m6s de 0.025% de silicio cristalino.
Peligros: Mezela de cemento fresco y/o cenizas volantes pueden causar irritation en los Ojos, quemaduras en piel y ojos, y
reacci.ones alergicas en la piel. Concreto seco y po.lvo de agregados, pueden causar irritati6n en los ojos, piel y/o en
la zona respiratoria. Polvo del manejo en el trituramiento, pulido, torte y/o perforaci6n puede contener materiales
silicos, los cuales pueden causar silicosis pulmonar y cancer si 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 liberation del amoniaco. La inhalaci6n del amoniaco puede causar toser, irritation o
quemaduras en la nariz, garganta y pulmones. Acudir inmediatamente al medico. El nesgo 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, proteccion en los ojos y ropa
Primeros adecuada para proteccion. 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 proteccion respiratoria.
Primeros auxilios: En caso de contacto en los ojos, inmediatamente fluya agua en la pane afectada por 15 minutes.
Si se inhala polvo, expongase a aire fresco. Si el cemento fresco tiene contacto con sus ojos, ]avelos a fondo con
agua. Acuda a atenci6n medica inmediatamente si la irritaci6n continua.
CEMEX, Memorial Hermann Tower
929 Gessner, Suite 1900
V7 combinado Houston, Texas 77024
02/ 12 Para mas .information v.isita www.cemexusa.com.