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SCANNED
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St. Lucie Countv
Plant:
Begin Loading:
To Job:
Arrive Job:
Start Unload:
Finish Unload:
Leave Job:
Return Plant:
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Customer Code:
Project Code:
Ticket Dale:.
Delivery Instructions:
Customer Name:
Project Name:
Delivery Address:
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Customer Job Number: Order Code Date:
rr. :.L' ib:
Project P.O. Number. Order P.O. Number.
Map Page: Map/Row/Column:;
Dispatcher:
Tlckel Number.
Due On Job:
Slump:
Truck Number:
Driver Number:
Driver Name:
End Use;
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LOAD
QUANTITY
CUMULATIVE
QUANTITY
ORDERED
QUANTITY
MATERIAL CODE
PRODUCTION DESCRIPTION
UOM
UNIT PRICE
AMOUNT
Cash
Check k/Auth Code:
Signature of Driver Receiving Cash:
Cash Received:
Total COD Order Amount to Collect
]Check
Without Standby Charges:
Charge
Comments:
WATERADDED: �r �' GAL
YARDS IN DRUM:
d
WHEN ADDED.
SIGNATURE
( CURB LINE CROSSED AT OWNER'S/AGENT'S REQUEST:
:-fall fnL {=UL- l_t?AD _ /L YARliS
r ' ❑ LOAD WAS TESTED BY: I '
Notice; Our drivers will make every effort to place materials where the customer designates, but the SPECIALTERMS: 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. Nocreditfor safety handling lnformaton, 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 AUTHORIZEDSIGNATURE�`
within one business day after the receipt of materials. O
X /
BSUNIVERSAL Y INVOICE
This Delivery Ticket incorporates herein by reference Buyer's previously executer' r'—dit Application, if any, Seller's Standard
Terms and Conditions, Seller's Quotat if any, and Seller's Order Confirmation ( tding limitations of warranties), as if fully
set forth on this Delivery Ticket ("Agn_-_._nt"). Seller will provide the Standard Tetix„ cnd 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.
AliliKhBAIL' / 1;ENMIV'1/ UtJfN UlKhI'K YKUllU(U'I'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 0.025% crystalline silica.
Hazards: Freshly mixed wet cement and/or fly ash can cause; eye iffltation, skin,and_e _e burns,and_allergic skin:reactions—
=— Dry'conerete—and aggregate dust -may 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 cah 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.
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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 visirwww.cemexusa.com.
Este ticket de entrega incluye Como referencia al comprador (ya previamente ejecutada en su aplicacidn de credito): cualquier
termino estandar, conditions del vendedor, propuestas del vendedor y orden de confirmaci6n del vendedor (con limitations y
garantfas), como acuerdo total del ticket de entrega ("Contrato"). El vendedor proveerd Ins terminos estandares y conditions detal-
lados en caso de asf set 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 tnenos que se identi-
fique con Una nota al frente de este documento.
F.T.ViN pl97,V11VN 1
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V 01.AiV 1'EN
Los productos de agregados son materiales naturales como piedra caliza, dolomita, granito, coca 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. Los productos de concreto incluyen cemento Portland y productos de agregados como piedra caliza, dolomita,
granito, rota volcdnica, arena, grava, y otros materiales silicios. Estos productos incluyen cenizas volantes (fly ash) la cual puede
contener mas de 0.025% de silicio crystalino.
Peligros: Mezcla de cemento fresco y/o cenizas volantes pueden causar irrit, c66n en Ins ojos, quemaduras en pie] y ojos, y
reacciones alergicas en la piel. Concreto seco ypolvo de agregados, pueden causar irritaci6n en los ojos, piel y/o en
la zona respitatoria. Polvo del manejo en el trituramiento, pulido, torte y/o perforacidn puede contener materiales
silicos, los cuales pueden causar silicosis pulmonar y cancer si son inhalados. En caso de ser ingeridos, mantenerse
en temperatura calida, reposary 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 duraci6n y el nivel de la exposici6n.
Seguridad: Evite el contacto con ojos y contacto prolongado con la pie]. Use guantes, protecci6n en Ins ojos y ropa
Primeros adecuada para protecci6n. Ldvese las manos con jab6n suave y agua despu6s del manejo de materiales. Evite inhalar
auxilios: polvos. Si se expone a polvos mas de los limites recomendados, use protecci6n respiratoria.
Primeros auxilios: En caso de contacto en los ojos, inmediatamente fluya agua en la parte afectada por 15 minutos.
Si se inhala polvo, exp6ngase a aire fresco. Si el cemento fresco tiene contacto con sus ojos• lavelos a fordo con
agua. Acuda a atenci6n medica inmediatamente si la irritaci6n continda.
CEMEX, Memorial Hermann Tower
929 Gessner, Suite 1900
V7 combinado Houston, Texas 77024
02/12 Para mas informaci6n visita www.ce
5858172/
SCANNED
BY
St. Luce Counts
Plant:
Begin Loading:
I
To Job:
- Arrive Job:
Start Unload:
Finish Unload:
Leave Job:
'Return Plant:
, et, I
I
. .
- - ,
Customer Code: Customer Name: Customer Job Number.
Project Code. Project Name:' Project P.O. Number,
Ticket Date: Delivery Address
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Delivery Instructions p a
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Order Code / Date.
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Order P.O Number..
TV''' V J V /''�'" iC',
Map Page: 'Map/Row/Column
Dispatcher.
Ticket Number.
r• 4r.'7
Due On Job:
,Slump:
Truck Number.
Driver Number.
Driver Name:
End Use:.
-,-
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LOAD CUMULATIVE ORDERED MATERIAL CODE PRODUCTION DESCRIPTION UOM UNIT PRICE AMOUNT
QUANTITY ODANTITY QUANTITY - -
,
Cash Check N/Auth Code:
Signature of Driver Receiving Cash:; -
Cash Received:
I Total COD Order Amount to Collect
-
-
-
Without Standby Charges:
Check
Charge
Comments:
Y
WATER ADDED: GAL
YARDS IN DRUM:
WHEN ADDED.
CURB LINE /CROSSEDIT WNER`S O/AGENT'S REQUEST:
///jjj Il \O
Xli) j YAGD SIGNATURE
z/J ❑ LOAD WAS TESTED BY:
Notice: Our dnvers. will make every effort to place materials where the � sl'tlnfer designates, but the SPECIALTERMS: Any water added is at customers own ask. lfwater is added on job, concrete strength
Company assumes no responsibility for damages inside curb or grope •line. Customer agrees to the is no longer guaranteed. WARNING: Product may cause skin and/or eye lactation. 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
contact after delivery,.this Company will not accept any responsibility for the finished results. Nocreditfor safety handling information, and to the materiel 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. O
65UNIVERSAL T`r 51 i ("V l.(7t$L7 e+(! IS'i a .l
CUSTOMER
This Delivery Ticket incorporates herein by reference Buyer's previously executed Credit Application, if any, Seller's Standard
Terms and Conditions, Seller's Quotal if any, and Seller's Order Confirmation uding limitations of warranties), as if fully
set forth on this Delivery Ticket ("Agn :nt"). Seller will provide the Standard Te 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. .
TE / CEAMNT / 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.
ury concrete ano aggregate dust may cause irritation to eyes, skin, andlor 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 www ceninusa.com.
Este ticket de entrega incluye Como re£erencia al comprador (ya previamente ejecutada en su aplicaci6n de cr& ito); cualquier
termino estandar, condiciones del vendedor, propuestas del vendedor y orden de confirmation. del vendedor (con limitaciones y
garantfas), come, acuerdo total del ticket de entrega ('Contrato"). El vendedor proveera los terminos estandares y condiciones detal-
lados en caso de asf set requeridos. Con este docurento, el comprador acepta los mismos ya antes mencionados y que las cantidades
y materiales fueron entregados cotito se cxpresa en el mismo. Acepta pagar el monto de acuerdo al contrcto 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 naturaley como piedra caliza, dolomita, granito. rota volcanica, arena. Brava y otros
materiales silicios. Los productos de cemento incluyen Cemento de tipo Portland, de albanileria, pozzolan (tipo IP); azulejo de
azotea y estuco. Los productos de conereto incluyen cemento Portland y productos de agregados como piedra caliza, dolomita,
granito, rota volcanica, arena, grava, y otros materiales sihcios'. Estos productos incluyen cenizas volantes'(fly ash) la cual puede
contener mas de 0.025% de silicio cristalino.
Peligros: Mezela de cemento fresco y/o cenizas volantes pueden causar irritaci6n en los ojos, quemaduras en piel y ojos, y
reactions al6rgicas en la piel. Coucreto seco y polvo de agregados, pueden causar irritaci64 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 Loser, irritaci6n o
qudmaduras en la nariz, garganta •y pulmones. Acudir inmediatamente al mcdico. El riesgo 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 auantes..protecci611.en los ojos y-ropa
Primeros adecuada para protecci6n. Ldvese las mane s con jab6n suave.y agua despuds del manejo de materiales. Evite inhalar'
auxilios: polvos. Si se expone a polvos mas de los limites recomendados,use protecci6nrespiratoiia.'
Priteros auxilios: En caso de contacto en los ojos, inmediatamente fluya agua en la parte afectada por 15 minutos.
Si se inhala polvo, exp6ngase a aire fresco. Si el cemento fresco tiene contacto con sus ojos, lavelos a fondo con
aqua. Acuda a atenci6n m¢dica inmediatamente si la irritaci6n continda.
CEMEX, Memorial Hermann Tower
929 Gessner, Suite 1900
V7 combinado Houston, Texas 77024
02/12 Para mas informaci6n visita www.cei