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Order Code I Date:
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LOAD CUMULATIVE ORDERED MATERIAL CODE'* wPRODUCTION DESCRIPTION UOM UNIT PRICE AMOUNT
QUANTITY QUANTITY QUANTITY.
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Cash Check # /Auth Coder Signature of Driver Receiving Cash: Cash Received: Total COD Order Amount to Collect
Without Standby Charges:
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WATER ADDED: GAL YARDS IN DRUM:
�` WHEN ADDED. .
SIGNATURE-
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f// CURB LINE' CROSSED AT OWNER'S/AGENT'S REQUEST:
�!� d ' SIGNATURE
Ll LOAD WAS TESTED BY:
lice: 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 c4 job, concrete strength
mpany assumes no responsibility for damages kAside curb or property line. Customer agrees to the is no longer guaranteed. WARNING: Product may cause skin and/or eye imtation;r CAUTION: Material
t s of sale and delivery and accepts concrete as is. Dua to impportant factors which are out of our may be hazardous to your safe�l and he f r `Pl�se refer to/the backside of/this ticket far important
too( after delivery, this Company will not accept any responsibilit the finished results. No credit for safety handling information, an to the mate al s, fety data shdets for additional,information.
rued concrete. Buyers exceptions and claims shall be deemeil'Waived urifi ss made to us in writing AUTHORIZED SIGNATURE: r %
in one business day after the receipt of materials;
NIVERSAL , P,-Zr i� Cr".-'t.� � 10 02 u,C-.i E..L�.�j;? tvI! nvl a
CUSTOMER
This Delivery Ticket incorporates her " 1)y reference Buyer,'s previ)u�1 i xecuted Credit Application, if any, Seller's
Terms and Conditions, Seller's Quota if any, an&Sclierys.,,Order nfrrmation.(i ling limitations of warrantids), as`
set forth on this Delivery Ticket. ("Agrcciricnt"). Seller will provide the , andard Tore id Conditions upon request Buyer a,.
a in accordance with the A recmer►t. i, q p ly agree
that,
y, unless otherwise noted oil the front hereof, all quantities and items ere delivered as indicated and further ex resst' \
AGGREGATE / CEMENT / CONCREJE PRODUCTS / FLY ASH I�
Aggregate products are naturally occurring materials .including limestone,., .., ite, granite, volcanic rock, sand, gravel, and other
siliceous materials. Cement products include Portland cement, masonry, pozzo,an, (Type IP), roof tile, and stucco. Concrete
products include Portland cement and aggregate products .including lime, tine, dololi rr_,granite, volcanic rock, sand;l,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 skii'i reactions.
Dry concrete and aggregate dust may cause irritation to eyes, skin, and/or respiratory tract. Dust frotri handling,'
crushing, grinding, cutting and/or drilling may contain silica, which may cause silicosis and cancerl;'uf inhaled.
If ingested, keep warm, at rest, and drink large amounts of water, Fly Ashmay 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 physidian. Health risk depends on duration and level of exposure.
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Safety: Avoid contact with eyes and prolonged contact with skinWear gloves, eye protection, and appropriate
. protective
clothing. Wash hands thoroughly with mild soap and water after handling. Avoid breathing dust. Ifj;exposed to
dust above recommended limits (see MSDS), wear suitable 1VIOSH-approved respiratory protection.1,1
First .Aid: In case of eye contact, immediately flush eyes with flowing water for 1.5 minutes. If dust is inhaled, m'cive 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 www,cemcxusa.com. n,
Este ticket de entrega .incl.uye como referencia al comprador (ya previamente ejecutada en su aplicacion de cred.i.to"); cualquier
termino estandar, condiciones del vendedor, propuestas del vendedor y orden de confirmacion del, vendedor (con limitaciones y
garan.t.fas), como acuerdo total del ticket de entrega ("Contrato"). El vendedor proveera .los torminos estarrdares y condiclones deta.l-
lados en caso de asf ser requeridos. Con este documento, el comprador acepta los mismos ya antes mencionados y que 1a.4 cantidades
y materiales fueron entregados como se expresa en el mismo. Acepta pagar el monto de acuerdo al contrato; al menos que se identi.-
fique con una rota 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 voleanica, 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 concrete, incluyen cemento Portland y productos de agregados como piedra calrza , do.lomita, _.
granito, coca voleanica, arena, grava, y otros materiales silicios. Estos productos inchnyen cenizas volantes (fly ash) la cual puede.
contener mas de 0.025% de silicio cristalino.
Peligros: Mezcla de cemento fresco y/o cenizas volantes ,pueden causar irritacion en los Ojos, quemaduras en pieli,,y Ojos, y
reacci:ones alergicas en la peel. Concreto seco y polvo de'agregados, pueden causar irritacion en los Ojos, Ijel. y/o en
]a zona respiratoria. Polvo del manejo en el'trituramiento, pulido, corte y/o•perforacion puede contener materiales
silicos, los cuales pueden causar silicosis pulmonar y cancer si son inhalados. En caso de ser ingeridos, rripntenerse
en temperatura calida, reposar y tomar grandes cantidades de agua. Las cenizas volantes pueden contener a1moniaco.
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Seguridad• La humedad puede causar la liberaci.on del amoniaco. La inhalacibn del amoniaco puede causar toser, irritacicin o
quemaduras en la nariz, garganta y pulmones: Acudir inmediatamente al medico. El riesgo en ]a salud 06'pende en
la duracion y el nivel de la exposicion.
Seguri.dad: Evite el contacto con ojos y contacto prolongado con la pie' uantes, proteccion en I l.. Use gces s y ropa oj
Primeros - adecuada para proteccion. Lanese las manos con labon suave y agua despues del manejo de materiales. Evite inbalar
auxilios: polvos. Si se expone a polvos mas de los limites recomendados, use proteccion respiratoria.
Primeros auxilios: En caso de contacto on los ojos, inmediatamente fluya agua'en la parte afectada por 1.514ninutos.
Si se inhala polvo, expongase a wire fresco. Si el cemento fresco tiene contacto con sus ojos, lavelos a fpndo.con
agua. Acuda a atencion medica inmediatamente si la irritacion continua.
CEMEX, Memorial Hermann Tower ,4
929 Gessner; Suite 1900
V7 combinado Houston, Texas 77024
02/12 Para .m.as informaciorr vis.ita www.cemexusa.com. i