HomeMy WebLinkAboutCEMENT PAPPERWORK)561 -�IV37A
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Plant:
Begin Loading:
To Job:
Arrive Job:.
Start Unload:
Finish Unload.
Leave Job:
Return Plant:
Customer Code:. Customer Name:
.'5 ?11 5Tr' NFIR10-.11. CO,'JCRETF..
Project Code:, Project Name:
Ticket Date: DeliveryAddress:
._t , 15 J1741 'LLl_I 1-EL- PD
Delivery Instructions:
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Customer Job Number.
Project P.O.. Number.
Order Code / Date:
7o5 i) /' 0/15
Order P.O. Number..
V't. 11, kr1L_
Map Page: Map/Row/Column:
Dispatcher:
Ticket Number:
Due On Job:
Slump:
Track Number.
Driver Number:
Driver Name:
End Use:
1, "a.'
E., I")ID 10
53t6 ;-tS2_:0
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REG WIL.I_f.Ai' S
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LOAD CUMULATNE
QUANTITY QUANTITY
r ORDERED
QUANTITY
MATERIAL CODE
- PRODUCTION DESCRIPTION
-
UOM
UNIT PRICE
AMOUNT
300tj
LILEND_DPRPM YG
la
7-0EL
SI)RCf+ARGI
CHARGE
`=1'RV,
PAYLVAD, C` P.RC- OVER, C
] Cash Check M/Aug, Coda: Signature of Driver Receiving Cash: Cash Received: Total COD Order Amount to Collect
Without Standby Charges:
] Check
Charge
Comments: J}
WATER ADDED: v GAL YARDS IN DRUM:
j WHEN ADDED.
c' SIGNATURE
-� /^ CURB LINE CROSSED AT OWNER'S/AGENT'S REQUEST:
�i�rl,'RL'.T[`_ DtSf-'OJf-1i_ FLr �,/"�/L� ..SAD
--�� SIGNATURE
PAR f IP1. FUt� C❑HD YARDS J LOA~ D W S TESTED- BY:
Notice: Our drivers will make every effort to place materials where the customer designates, but the SPECIAL TERK Any water adLed 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 a I Nation. CAUTION: Material
terms of sale and delivery antl accepts concrete as is. Due to important factors which are Rugafmn �ma—yTie"haumdit�N your sae Please refer lathe-theside of this ticket for important
control after delivery„ this Company will not accept any responsibility for the finished results. Nocreditfor satery handling info align, 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 SIG ATURE
within one business day after the receipt of materials. O \ )
'RUNIVERSAL PREV IRK: INVOICE
LOAD NMI; 1
This Delivery Ticket incorporat-- herein by reference Buyer's previously eyponted Credit Application, if any, Seller's Standard
Terms and Conditions, Seller's ation, if any, and Seller's Order Confirn n (including limitations of warranties), as if fully
set forth on this Delivery Ticket , ..geement"). Seller will provide the Stand__ : erms 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.
AliliKEliAlE / ULIVlEN'1' / UONC RKYE YKODUU'1'S / YLY 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 0.0250/o-crystalline silica.
Hazards: Freshly mixed wet cement and/or fly ash can cause eye irritation, skin and eye burns and allergic skin reactions.
A Dry concrete and aggregate dust may cause.irrita(wiLto eyes, skin, a nd/or.respiratorytract.-Dust-from-handling,.
6r i&na, grmi ing, cutfin�/or drilling -may contain silica, wliici 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 bums of the nose, throat and lungs. See physician. Health risk depends on duration and level of exposure.
Safety: Avoidcontact 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
V7combined Houston, Texas 77024
02/12 For more information please visit www.cemexusa.com.
Este ticket de entrega incluye como referencia al comprador (ya previamente ejectnada en su aplicaci6n de credito): cualquier
termino estandar, conditions del vendedor, propuestas del vendedor y orden de confrrmaci6n del vendedor (con limitaciones y
garantfas), como acuerdo total del ticket de entrega ("Contrato"). El vendedor proveera los terminos 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 contrato; al menos quo se identi-
fique con una nota al frente de este documento.
/ UENIEN'11) / YKO1)UU'1'OS llE
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 albahilerfa, pozzolan (tipo IP), azulejo de
azotea y estuco. Los productos de concreto incluyen cemento Portland y productos de agregados coma piedra caliza, dolomita,
granito, roca volcanica, arena, Brava, 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 irritaci6n en los ojos, quemaduras en pie] y ojos, y
reactions alergicas en la piel. Concreto seco y polvo de agregados, pueden causar irritaci6n 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 set ingeridos, mantenerse
en temperatura cdhda, reposar y tomar 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, irritaci6n o
quemaduras' en la nariz, garganta y pulmones. Acudir inmediatamente al medico. El riesgo en la salud depende en
la duration y el nivel de la exposici6n.
Seguridad: Evite el contacto con ojos y contacto prolongado con la pie]. 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 los limiter recomendados, use protecci6n respiratoria.
Primeros auxilios: En caso de contacto en los ojos, inmediatamente fluya agua on la parte afectada por 15 rninutos,
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 medica inmediatamente si la irritaci6n continua.
CEMEX, Memoria] Hermann Tower
929 Gessner, Suite 1900
V7 combinado Houston, Texas 77024
02/12 Para mas informaci6n visita www.cemexusa.com.
SUPERMIX
NE
i4 `The OnL CO Concrete Company" /JC. �jII�91�II1Ci1 1�IIIIIII1Ilot!
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�t CENTRAL CONCRETE SUI'ERMIX, INC. II
CONCdETE DISPATCHERS(}Unty
MIAMI-DADS: 1305) 284-7101
DEERFIELD: (9
54) 4so-9333)�. LNOR�JRU
OMER. NO."DELIVERY TICKET DATE
BLOCK PLANT: (305) 805-3226 U
• WWW.SUPERMIX.COM 2T/ 3 ]/11,'14'lGF3.]fi1
MAIN OFFICE: 4300 S.W. 74th,Ave. - Miami, FL 33155
PHONE': (305) 262-3256 FAX: (305)267-0668
SERVING MIAMI-DADS, BROWARD, PALM BEACH, MARTIN & ST.'LUCIE COUNTIES
SOLD TO
DELIVERYADDRES I
<IOIt'JEl-L HU � f;t'
314;Qv 111-L.L. f; fd RD.
Fr. F'TFP.C'E
POO ULf ICH F r
VORTOUS FOBS
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1_0T /L;LOC:i , n Ab I 68P013
114'i I KI.II_ I dJ !I+t`i
QUANTITY
DESCRIPTION
PRICE
UNIT
EXTENSION
!. ;i4:7
:. S'i411 =4 -. .A,1VUA 1'1[4'[11 40
F-IIFL_ SUR
ENV FEE
1
MINUTES ALLOWABLETIME• PER MINI. rE
_'
EXTRA UNLOADING TIME CHARGE X $1.00
—
*6 MINUTES PER CU. YD. ALLOWED SHORT _LOAD CHARGE y
SLU P
`i_; "
THIS DELIVERY TOTAL CU. YDS:
AMOUNT
OF YOUR ORDER FOR CU. YDS.
TAX
CUSTOMER OR HIS AGENTASSUMES FULL RESPONSIBILITYFOR STRENGTH AND/OR
PERFORMANCE OF ANY CONCRETE PLACEDABOVEDESIGN SLUMP OR WHEN
• ♦
1
WATER ISADDED. WATER ADDED ❑ YES ❑ NO GLS.
TIME ARRIVED ON JOB
STARTED UNLOADING
FINISHED UNLOADING
LEAVING THIS JOB
TOTAL TIME
9 L 11a Zz 2�aGtGiQ'c
SUBJECT TO THE.TERMS, CONDITIONS AND "CAUTION" WARNING LISTED ON BOTH THE
FRONT AND BACK OF THIS TICKET.
TRUCK DRIVER I acknowledge that I have received and accepted the materials listed on this•ticket. I
h D understand and agree to the terms on both the front and back of this ticket.
RECEIVED BY: X
CONTROL 20 LOADING POINTS AT 16 LOCATIONS TO SERVE YOU BETTER
c 1 MIAMI• DOWNTOWN MIAMI -WEST MIAMI •AIRPORT• OPA-LOCKA-MEDLEY . PERRINE • PEMBROKE PINES-`l
"' 4- �`L DEERFIELD • BOCA RATON • _RIVIERA BEACH -STUART • W. BROWARD • FT. PIERCE • E. BROWARD • DELRAY ill
u23' d ' PRODUCERS AND SUPPLIERS OF QUALITY READY MIXED CONCI�IE AND CONCRETE BLACK NRMCA
COPY.
CAUTIONH FRESHLY MIXED CEMENT, MORTAR; CONCRETE 'OR
GROUT MAY CAUSE SKIN INJURY. AVOID CONTACT WITH EYES WHERE
POSSIBLE AND WASH EXPOSED SKIN AREAS PROMPTLY WITH WATER.
IF ANY CEMENT MIXTURES 'GET INTO EYES, RINSE IMMEDIATELY AND
REPEATEDLY WITH- WATER AND GET PROMPT MEDICAL TREATMENT.
-REPEATEDLY
OF C -"OR-GRINDING-ONCRETE"MASONRTUN`ITS-MAVRESULT
IN THE'RELEASE OF DUST PARTICLES WHICH, WITHOUT THE, USE OF
PROPER EYE OR RESPIRATORY PROTECTION, COULD CAUSE EYE OR
NOSE IRRITATION. THE MATERIAL SAFETY DATA SHEETS FOR THE
PRODUCTS SOLD BY CENTRAL CONCRETE- SUPERM IX, INC. ARE
AVAILABLE UPON REQUEST , s.
UNLOADING DRIVERS ARE PROHIBITED FROM DELIVERING
CONCRETE EXCEPT UNDER THE TRUCK'S OWN, POWER, AND WHERE
SITE CONDITIONS PERMIT THE SAFE AND PROPER OPERATION OF HIS
EQUIPMENT. DRIVERS ARE NOT PERMITTED TO ADD WATER TO THE
MIX NOR TO GO BEYOND THE CURB LINE, EXCEPT UPON THE
AUTHORIZATION OF THE PURCHASER/PURCHASER'S AGENT AND HIS
ACCEPTANCE OF RISK FOR ANY LOSS OR DAMAGE.
BUYER, OR HIS AGENT, AGREES TO ASSUME RESPONSIBILITY FOR
CONCRETE, AND ANY PROPERTY DAMAGE,RESULTING FROM TRUCK
MAKING DELIVERY BEYOND CURB LINE. ALL CLAIMS MAST BE MADE
AT TIME OF DELIVERY.
IF, IT BECOMES NECESSARY TO BRING ANY ACTION TO COLLECT.
AMOUNTS DUE ON THIS INVOICE, PURCHASER SHALL BE'RESPONSIBLE
FOR REASONABLE ATTORNEYS FEES AND COURT COSTS INCURRED
BY VENDORAN SECURING COLLECTIONS. INTERESTSHALLACCRUE
AT' 1 1/2% PER MONTH ON OUTSTANDING BALANCES.