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Customer Code
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Order Code / Date:
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Instructions:
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Truck Number;
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LOAD
QUANTITY
CUMULATIVE
QUANTITY
ORDERED
QUANTITY
MATERIAL CODE
PRODUCTION DESCRIPTION
UOM
UNIT PRICE
AMOUNT
10 50 :. u Q D 52.50
1 E-7307d 33 ;:,O(Di;) ..FLESJF 15E.R ` tie 75 LES M
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12,G? 4 TMV T. &�ONMENI fit. CHARGE'
Cash . Check # /Auth Code:
Signature of Driver Receiving Cash:
Cash Received:
Total COD order Amount to Collect
Check
Without Standby Charges:
Charge
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Comments:
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— WATERADDED.: � I_GAL • YARDS IN DRUM:
WHEN ADDED..
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SIGNATURE
CURB LINE CROSSED AT OWNER'S/AGENT'S REQUEST:
DISPOSAL FEE
.I AL_ � FULL
'�._O�45 ' YnRDS'
SIGNATURE
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0 LOAD WAS TESTED" BY: s
Notice: Our driversiwill
Company assumes
make every effort to place materials where" the_ customer' designates, but the
r o responsibility for damages inside curb or property line. Customer agrees to the
SPECIAL TERMS: 'Any water'added is at, customers own risk. If water is added on job, concrete strength
is no longer guaranteed. WARNING: 'Product may cause skin and/or eye irritation. CAUTION: Material
terms' of sale and delivery
control after delivery;
and accepts concrete as is. Due to important factors which are out of our
this Company will not accept any responsibility for the, •finished results. No credit for
may be hazardous to' your safety and health. Please refer to the backside of this ticket for important
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 torus in writing
within one business day after the receipt of materials.
AUTHORIZED'S GNATURE:
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INVOICE...
This Delivery Ticket incorporates herein b- 1--ference Buyer's previously executed Credil--Application, if any, Seller's Standard
Terms and Conditions, Seller's Quotation, iy, and Seller's Order Confinnation (inclu ; limitations of warranties), as if fully
set forth on this Delivery Ticket ("Agreemc '. Seller will, provide the Standard Terms a..... -'onditions 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 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 NIOSII-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 www.cemexusa.com.
Este ticket de entrega incluye como referencia al comprador (ya previamente ejecutada en su aplicacion de credito); cualquier
terrnino estandar, condiciones del vendedor, propuestas del vendedor y order de confixmacion del vendedor (con limitaciones y
garantfas), como acuerdo total del ticket de entrega ("Contrato"). El vendedor proveerd los terminos estandares y condiciones detal-
7'r1ados en caso de asf ser requeridos. Con este documento, el comprador acepta los mismos ya antes mencionados y que,tps cantidades
y materiales fueron entregados como se expresa en el mismo. Acepta pagar el monto de acuerdo al contrato: at 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 cal.iza, dolomita, grani.to, rota volcdnica, arena, Brava y otros
materiales silicios. Los productos de cemento incluyen Cemento de tipo Portland, de albanilerfa, pozzolan (tipo JP), 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 silicios. Estos productos incluyen 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 piel y ojos, y
reacciones alergicas en la piel. Conereto seco y polvo de agregados, pueden causar irritacion en los oja`s, piel y/o en
la 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, mantenerse
en temperatura edlida, reposar y tomar grandes cantidades de agua. Las cenizas volantes pueden contener amoniaco.
Seguridad: La humedad puede causar la liberacion del amoniaco. La inhalacion del amoniaco puede causar toser, irritacion o
quemaduras en la nariz, garganta y pulmones. Acudir inmediatamente a] medico. El riesgo en ]a saluc depende en
la duracion y el nivel de la exposicion.
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 .m:anos con jabon suave y agua despues del manejo de materiales. Evite inhalar
auxilios• polvos. Si se expone a polvos mas de los limiter recomendados, use proteccion respiratoria.
Primeros auxilios: En caso de contacto en los ojos, inmediatamente fluya agua en la parte afectada por 15 minutos.
Si. se inhala polvo, expongase a aire fresco. Si. el cemento fresco ti.e.ne contacto con sus ojos, Nvelos a fondo con
agua. Acuda a atencion med.ica inmediatamente si la irritacion continua.
CEMEX, Memorial. Hermann Tower
929 Gessner, Suite 1900
V7 combinado Houston, Texas 77024
02/12 Para mils informaci6n visita www.cemexusa.com.
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CURB 1• {NI=.CRbSSD AT`OVYNEC'S/AENt`5 REQUEST:
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N0ft0e:•"OLrdrtvg4 Will snake'evC,rtr 4fiort to PJace mBterlafe wngr¢fhb.�ugtpmpt tl� tg�rgtes, QOt;NYp. SPECIALTEt;MS �An'yy�teraCRed eatcusloineraownptk, hyrete3rieadde¢an+ob,oci tw olm). Company assltmes no res�anolbilt}y for dsrruagee ihsldb:Curb or property 110.- Uitomor $1 roes, to the is no iting'ef gliareMeatl: 1KAfiNMr., product may cause 6kln 8ndlor gyp Irritotlon, CAUrON: Mete
terms of safe end dolivery and weptd mgci tle. as is; due to impodont rndoro •whloh onq but.of•oui, rrt0y+ be hoti;,rdotis to yot+r sefeTy and haslib, Please refer to the backside of this ticket for Import
control attar dgl veryy tHla GdrttpanY will not ace5pl any,'respon. blllIYI* the firt(¢bed'C6autts, No Cf>4t:tdd apf6)0insltlnp tnfoi.Matt rj, and t6 WAsterial safety data sheets for addigonal Infornwon.
tRflfined Concrete' t3uYsrs dXt*Oflong and claims shall 4d deemed waived unless Made to as In wrlHQR,V 3tGNATURE:
Neithlnorl "sin®sq4yaf{arthe fecepl,d£irreleri�le,
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