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SUBMITTED PAPERS - 1
N 4 ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED SCANNED Date: BY Permit Number: St. Lucie County RECEIVE r W Building Permit Application AUG 1,�. 2015 Planning and Development Services Building and Code Regulation Division PERMITTING 2300 VirglnlaAvenue, Fort Pierce FL 34982 St. ie County, FL Phone: (772)462-1553 Fax: (772) 462-1578 Commercial Residential PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of lines PROPOSED IMPROVEMENT LOCATION,: 2q Address: Legal Description: Qh �p opertyTaxlDq:�7 1�i�`Jr�rO Q'Sa '(Q�� Lot No. Site Plan Name: — / Block No. Project Name: Setbacks Fron Back: Right Side Left Sel I Ilk id DETAILED DESCRIPTION OF WORK: CONSTRUCTION INFORMATION: III Aaamonai worK to ue errormea unaer tins perm¢— cnecK au apply: I� []Electric Gas Tank '❑Gas Piping _ Shutters j❑� Windows/Doors []Electric El Plumbing []Sprinklers 11 Generator I�QRoroof P—W Total Sq. Ft of Construction:3�s 5 Ft. of First Floor: 0 U /� /1 _� IRJI I i Cost of Construction: $ 3�3�, f%/ Utilities: Sewer LJ Septic Building Height: OWNER/LESSEE:. CONTRACTOR;Y, Name Name: I Address:6 [E� i_l_ Company: A w¢ City: —X4 ��L Q/dt� Zip Code $_� Fax: Phone No. r State: Address: It'j e% City: �/�/�� 0 Zip Code: 1 Phone No. D Fax: — �d� State:l' c-- s E-Mall: Mlz //0 Ll 0460pleo Fill in fee slmple Title Holder on next palfe from the Owner listed above) ( if different E-Mail: State or County License: C 066 �If value of construction Is $2500 or more, a RECORDED Notice of Commencement is required, Y- N SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION: DESIGNER/EM _ Not Applicable MORTGAGE COMPAL: _ Not Applicable Name: Name: IV ✓� Address: Address: City: State: _ City: State: Zip: Phone: Zip: Phone: FEE SIMPLE TITLE HOLDER: _ Not Applicable BONDING COMPANj': _Not Applicable Name: Name: 1 // U Address: Address: City: City: Zip: Phone: Zip: Phone: I certify,thatno work -or installation has commenced -prior to the issuance of a. permit. St. Lucie County makes no representation that is granting ape rm It will authorize the permItholder to build the subject structure which is in conflict with any applicable Home Owners Association rules, bylaws or and covenants that may i estrict or,prohibit such structure. Please consult with your Home Owners Association and review your deed for any restrictions which may apply. In consideration of the granting of this requested permit, I do hereby agree that I will, in all respects, perform the work In accordance with the approved plans, the Florida Building Codes and St. Lucie County Amendments. The following building permit applications are exempt from undergoing a full concurrency rev7or m additions, accessory structures, swimming pools, fences, walls, signs, screen rooms and access4red er non-residential use WARNING TO OWNER: Your failure to Record a Notice of Commencemenyour paying twice for improvements to your property. A Notice of Commencement must beposted on the jobsite before the first inspection. If you intend to obtain financing, consult wattorney before commencine wark or recordine your Notice of Commencement. .'/Signature of Owner/ Lessee Agent `Signature of Contractor/License Holder STATE OF FLORIDA STATE OF FLORIDA OA COUNTY COUNTY OF�� The forgoing Ins u nt wasa knowledg d efore me this Tay of���� U . 26y (Name of person acknowledging ) (Signature of Notaigr Publio- 9t�e oJFlorida ) Personally Known OR Produced Identification Type of Identification Produced Commission No, bonded Revised 07/15/2014 FF014070 The forgoing instrumelw s acknowledged before me this day of 20 IFJ by (Signature PNotary Public- State of Florida ) Personal Known __K__ OR Produced Identification Type of Identification Produced Commission No.� _ pvnulfit4>�kln REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE 13 I COMPLETE ` (� INITIALS - Pell PLANNING AND DEVELOPMENT SERVICES DEPARTMENT Building and Code Regulations Division BUILDING PERMIT //� , I SUB -CONTRACTOR SUMMARY T/�U77 YJ�L C F ^"' O�YY1(2_ will be using the following sub -contractors for the (Comps/Individual N me) project located at L.47/5e — (Street address or Property Tax ID #) It is understood that if there is any change of status regarding the participation of any of the sub -contractors listed below, I will immediately advise the Building and Zoning Department of St. Lucie County. Trade Name of Company/Contractor St. Lucie County/ State of Florida License Number Electrical �(/� C�27lZ /� Plumbing A. HVAC/ Mechanical Roofing Gas OFFICE USE ONLY:' PERMIT QQ �QQ ISSUE DATE: NUMBER: �,�u } �`7 �. U� Revised 07/29/2014 —PRO PLANNING &-PIP, VE LOPMENTSE RVI 9 Building Code. Cpn!p1i'mi&Wdsion z MWI� BVIO)ING� PERMIT %tt�� SUB-CONTRACTOWAGREMENT St. LllcleColljlt - QoWracto _yCeitificatloil Number;: Y. Stato bf iii -715 014,� CdrdfloatioliNuill er (If Ipplicable). EL-e 6-+r V sub-coWroctor fqrlldOW� (AW 42ZI12 W tj�_ (Typc.offradc). (Pril))6iy Coptrack�rr/ for -the P,170j, ect Itis undOrstoodliat, if thereis qaydjppgeof status,regardili U'i 6ift, �Art i 'patiou ikith the ic al ove,raenfioiied PKOAefbwall jnupedia ly advise: the-Iluilding and2dnhig Depgfffil Wa, pfSf. UlOv'Col."Ity by-odsidlially fjjjj)g,-,0,'(-fitjjgC,pf SLCCDV No. (104-'00) BUSI WSQUALIFIER, (xaiiieofthe Individual shoNvtioiithe 'CDiitrAdtor'$,Ljcqi,iir-) qRl AL,Sl 0' 4LS —SlGjN7AT, PRINT NAME. -DATE --D e l -ALr -EL,-&+(-(Cud c Se I Add(css:: S 3 s ce3 U� city/sultemp: C-A FL- 3 a7l I— phollo: 1 a) cinaii: o rt anJc) t=-ke I c Je),5ar eDq-- a — 'x- PLANNING aka DEVELOPMENT SERVICES O J'$uilding Code Collipliance Divisioll BUILDING PERMIT Iasi 9r SUB•CONTI2ACTOR AGREL'"ENT St. Lucie County Contractor Certification Number: Slate of Florida Certification Number pfappiicable): �,� - � C have agreed to b be the ` (omparry Name/tndnadual i L m suh-contractor for (Primary oulractor) (Type of Tra 2� A /k�= for the project located ate ✓ / n (Project Street Address or Property Ta ID H) It is understood that, if there is any change of status regarding our participation with the ately advise the Building and Zoning Department above mentioned project, I will inunedi of St. Lucie County by personally filing a Change of Contractor notice. (Form: SLCCDV No. 004-00) BUSINESS QUALIFIER (Name of the Individual shown on the Contractor's License) ORl' t AL56C' IRED TUI2tsS ARCRi QU SIGNA / ^ P IN )` ( Y X" BasinessNanre: Address; City/State/Zip: 4l T entail: Phone: /f-a8-(!r DATE fijsl©rlS- Cc EPLANNING &a IDEVEL(Dj'IVII;J� T SERVICES Building &c Code ComplianceDivision PERMIT gUB-CONTRACTOR AGIREl3NiE,N'I' SI. LncieCuunty Contractor cei'lificatio i Nuptbei: Slate of Florida Certification Number (If applicable): A C -- Pta-tei have agree([ to be the (Company Name/Int iduai Nanrc) (lip �fnn Ccc� sub-coutractorfor —k (Type of Trade) �� Contractor for [lie project located at �T`� (Project Street _ ddress or Property Tax D I It is understood that, if there is any change of status regarding our participation with the above mentioned project, I will immediately advise the Building sodZoning Departntelit ofSt Lucie CouiiLy by liersdrially filing a Chapge of Contractor notice. (Form: SLCCDV No. 004-00) 13USINESS QUALIFIEIR '(Name of the individual shown on the Contractor's License) ;ORIGINAL SI iA"' RE,S ARP IRRQUHZED T PRINTNAME DATE Business Name: Address: City/State/Zip: Phone: LOfr� LqC PERMIT # ISSUE DATE PLANNING & DEVELOPMENT SERVICES Building & Code Compliance Division BUILDINGPERMIT SUB-CONTRACTORAGREEMENT St, Lucie County Contractor Certification Number: State of Florida Certification Number (if applicable): CCC 3-?uo8 q We;(li, KLV f'M , 7"f, I MiA41 t'.iAU J have agreed to be Sub -contractor For the project located at._-,�l- � 3? b (Project Sir= namess or Property Tax I It is understood that, if there is any change of status regarding our participation with the above mentioned project, I will immediately advise the Building and Zoning Department of St. Lucie County by filing a Change of Sub -contractor notice. (Form: SLCCDV (No. 004-00) BUSINESS QUALIFIER (Name of the Individual shown on the Contractor's License) NOTARIZED SIGNATURES ARE REQUIRED Business Name: Address: City/State/Zip: thAL NF / ✓tl Q- cFL Jylo I Phone: t'2) 781.0900 email: b4kre&4cy(+%��nJ�SWIh •nQ� • M�I�I w�lsk �/ ,� � S .N I PRINTNAME DA E STATE OF FLORIDA, COUNTY OF LkGI? . THE FOREGOING INSTRUMENT WAS SIGNED BEFORE ME THIS &NAY OF 20 BY % OIO kys r , WHO IS P'- " Y ",. "`'Y OR HAS PRODUCE. AS IDENTIFICATION. (STAMP) E R NT NA E OF NOTARY SI SLCPDS: 09/06/2014 MaT [E� rItEMIsaPPlon MY COMMISSION It EE 0458M EXPIRES: October 22.2016 .14 Biaided TbrullotaryPu8lk Undewitem EH/ ^ D ISSUE f�U'tR tl 4`l rg Yr PLANNING & DEVI• LOPMCNT SERVICES Building & Code Compliance Division BUILDING PERMIT SUB -CONTRACTOR AGREEMENT St. Lacie County Contractor Certification Number State off loridn Certification Number (1repplicnhle): Sunshine Roofing, LLC 25387 CCC1327796 roofing Sub -contractor for, (Type of'rrade) For the proiect Iocatc(I at c (Project Sat Adcrressdi, Propedy'I'as have agreed to be the It is understood that, if there is any change ofstatus regar(ling,out participation with the above mentioned proiedt, I will immediately advise theBuil(ling and Zoning Department ofSt. Lucie County by filing,a Change ofSub-contactor notice. (Pormi- SLCCDV (No.004•00) BUSINE 88 QUALI iER (Name of (he Judi =ideal Shotvn on the Contractor's License) NOTARIZrD SIGNATURES ARE REQUIRED Business Name: Address: City/Stale/Zip; Phone: S A'PURr o Box 1083 Palm City, FL 34991 772-260-81R5 email': sunshineroofingllc@gmail,com Jamie Cisco PRINTNAItTE DATE STATEOF FLORIDA, COUNTY OF f 'I'llETOREGOING INSTRI UNIENTWAS SIGNED BEFORE NIE TIISevr� DAY OF ,20 B'� t �Q WIIO IS PERSONALLY KNOWN OR HAS PRO UCED AS IDENTIFICATION. FF 014070 SIGNATURE OF iNOTiARY 'UIILIC PRINT NAME( SI.CPDS: 09/06/2014 QdJ4)1vt i Planning& Development'Services it 1 r tstk I�'!4' Building & Code Regulfllions Division 2300virg!nlnAre. iff?fit+1�k4" !1 if Rp 1 (1 firlH' 7,—1 Carl Pierce, FL ''•'< ..,"?r4` •..�'.;'C::% (772)462.1559 In1462.1578 CHANGE OIr CONTRACTOR Or subcontractor or Cancellation of Permit CliailgeWCaab'Iclor is to, be completed by Ilse property awacr, muI lhonew contractor of record for the current perinit. A new permit applicalion.must also be completed tvith new conh'actor information, signature, alld h.'Insfer fee. A new Notice of Commcncentent must be fled f l the lien' coutmetor's 11,11110, I'or job values greater than $2,500 (S7,5011 if A/C Chmlgo-out),. A recorded copy nowt be subrnilted prior .to commencing II), work. Subcowroctor'chnnges can be completed by file general confroctor• Absent extenuating circumstances, a cancellation of permitis to be executer( by both file owlior and;gtia I i fier of record. a [)diet 1o•s:2nt6 Permit Number: 1520;0287 16/ V" 6- O fife Alld fl'$S7 3031 buneside Driva W619n Roofiny: ____Slaw License SLC License 29570 �$b-7$ nriginni Uencral Conn'actol"(pr SuBconapcim�). Sunsl�inti RecUna State License Ccc027796 ^SLC, License 25087 \elrUeneral Contnlclor (or Sobconlroctor) -- Reason for Change Cou!dn'tdoMeivo:x file undersigned (foes her )y agree to indemnifvmnd hold harmless St, Lllcic tlllly, its officers, agents, and em1 ployees o all costs fees, ordmnagers arising from any c )claims ofaclion for any reason wine t a Ise as a lesuh of this than re of conh'acflinsu on (ot or cancellafion.of b pclnln A parnly_ e', I e cancclled'If n'ori< has beeh;pet fm•urcil. �� real::;[ NA Elf/r%, /1' 111f{Z-f%U PRINT �I rc ufI InRJo, C rnn!q nrSl 1 uu (n1 n9 �If !dal ang r it .l flat ar�Qr� dg �fa�r�vlp!f / /�/Yls{ �. + Le Is poet nail) 1 Hatt to nx 51n.tielr of ::Snmtr D: [�' Sri vp Fei_s:t P+� 'ail. HIhNCES DONZA rya I C05(UISS!oY@PP 014070 E%PIKES; .lyy27, 2017 Oohed TAn! aolUry Funi UnEomi!za State ofFlariJn, Covmv of S! Lurie Comity _Tr/otent 6�f^}N�l_d� ore t yla.a� 01TQ(0Idt pf a to proliicoa a41D���y���,/ 5(}nnalreyf,S'ogrn• U.dr 77 allf)CQl1CrD: ' ,� hs(I•, 171MCCS 004L: r +F 1 n =F EXPMES Jay N 2U17 87:� aor9ee TMutUlary "'Jul Pon St. Lucia F13PE CA# 4930 521 NW Enterprise Dfta Pad SL Wde. FL 34988 Phone: n2"924-35751 F. n24)24 580 gSog -o2F-7 Soil Nuclear Gauge Client: Project: Report Date: 10/5/2015 Tarpon Flats 13-2092.03 Test Method: ASTM D 6938 277 Royal Poinciana Way- Suite 156 Tarpon Flats (Previously Seaside) Palm Beach, FL 33480 North A1A St. Lucie County, FL Test Results Test # Retest Of Test Date Proctor ID Method Sol[ classification Optimum Moisture (%) Maximum Dry Density (pcf) In Place Moisture (%) In Place Dry Density (pcf) Probe Depth (in) Percent Compaction Min/Max Comp. %) Remark 1 919/15 P-1 N/A 10.0 112.0 9.3 108.1 12 97 951 105 Pass 2 919115 P-1 MIA 10.0 112.0 9.1 108.6 12 97 95 / 105 Pass 3 919115 P-1 N/A 10.0 112.0 9.3 108.2 12 97 95/105 Pass Test Information Test # Test Location I Elevation Reference Gauge Make / Model / SN Field Technician 1 Below Slab Grade: Foundation Pad, Lot No. 19, Northeast Area 0 - 1 Troxler 3430 35058 12oyle, John 2 Below Slab Grade: Foundation Pad, Lot No. 19, Center Area 0-1 Troxler 3430 35058 Boyle, John 3 Below Slab Grade: Foundation Pad, Lot No. 19, Southwest Area 0 - 1 1 Troxler 3430 35058 Boyle, John Remarks I Comments Related Tests Pass: Tests results Comply with specifications Tests am *Direct Transmission' (Method A) unless probe depth is noted as "Backscatter'. Gauge calibration data on file with the testing agency. I Test # I Related Test # Test Type Test Reports shall not be reproduced, except in full, without the written approval of GFA International Inc. ��t�uetneeeeto Q W. O eso� � 1140 5 �` o 0 Page 1 of 1 SJONI � Soil Nuclear Gauge Report Date: 10/5/2015 Test Method: ASTM D 6938 Port St. Lucie FBPE CA# 4930 521 NW Enterprise Drive Port St Lucie. FL 34986 Phone: T72-924a575 I Fax 772-924-3580 Client: Tarpon Flats ` 277 Royal Poinciana Way- Suite 156 Palm Beach, FL 33480 Project: �"qm 13-2092.03 Tarpon Flats (Previously Seaside) North A1A St. Lucie County, FL Test Results " Test # Retest Of Test Date Proctor ID Method Sofl Classification Optimum Moisture I[% Maximum Dry Density (pcf) In Place Moisture (%) In Place Dry Density (pcf) Probe Depth In) Percent Compaction MInlMax Comp. (%) Remark 1 9/9115 P-1 N/A 10.0 112.0 9.3 108.1 12 97 951 105 Pass 2 9l9/15 P-1 N/A 10.0 112.0 9.1 108.6 12 97 951 105 Pass 3 9/9/15 P-1 N/A 10.0 112.0 9.3 108.2 12 97 951 105 Pass Test Information Test # Test Location I Elevation Reference Gauge Make / Model / SN Field Technician 1 Below Slab Grade: Foundation Pad, Lot No. 19, Northeast Area 0-1 12-1 Troxler 3430 35058 Boyle, John 2 Below Slab Grade: Foundation Pad, Lot No. 19, Center Area 0-1 Troxler 3430 35058 Boyle, John 3 Below Slab Grade: Foundation Pad, Lot No. 19. Southwest Area 0 - 1 Troxler 3430 35058 Boyle, John Remarks Comments Related Tests Pass: Tests resultscomply with specifications Tests am "Direct Tmnsmission' (Method A) unless probe depth is noted as'Backscatter". Gauge calibration data on file with the testing agency. I Test # I Related Test # Test Type Test Reports shall not be reproduced, except in full, without the written approval of GFA International Inc. 0 � No 60675 9 ®a •t}o o e J'3 TLi�j� 4 J` o :OR I'Dt;: fie. ®�OiS,��NALE��,a ��% Pagelofl Planning & Development Services Building & Code Regulation Division 2300 Virginia Avenue Fort Pierce, FL 34982 Phone:(772)462.2172 Pax:(772)462.6443 REVIEW COMMENTS 2 Comment: • PLEASE SUBMIT THE ENERGY PERFOMANCE SHEETS OR SUBMIT A THE NFRC FENSTRATION 9/15/2015 MANUFACTURE CERTIFICATE FOR THE U-FACTOR AND THE SHGC SHOWING COMPLIANCE WITH CHAPTER 4 SECTION 402.1.1 OF THE 2014 ENERGY CODE FIFTH EDITION. Comment: • PLEASE NOTE THAT THE COMMENTS ARE FOR THE CLARIFICATION OR CORRECTION OF THE 9/15/2015 SUBMITTED DOCUMENTS. ADDITIONAL REVIEW MAY BE REQUIRED AFTER SUBMITTING CORRECTED DOPI,,VE TS. Comment: CALLED1KEITH�GLARK<(3 HI AMPT,ONOAYI ON 9/17/2015 NEED TO'SUBMtT�ALL.STRUCTURAL. 9I17I2015-DR AWINGSiFOOR 3931 DUNESIDE DRIVE ZONING REVIEW COMPLETE Lydia Galbraith 8120/2016 8127/2015 8/27/2015 Comment: Planning & Development Services Building & Code Regulation Division 2300 Virginia Avenue Fort Pierce, FL 34982 Phone:(772)462.2172 Fax:(772)462.6443 Address: 3931 Duneside Dr. City / State / Zip: Fort Pierce, FI 34949 Parcel #: 1423-566-0022-00011 REVIEW COMMENTS 1 Owner(s): Armando A Pardillo Jr Jurisdiction: SAINT LUCIE COUNTY Zoning: HIRD Lot#: 19 APPLICATION INFORMATION Permit Number: 1508-0287 Stories: Permit Type: BUILDING RESIDENTIAL (SFR UP TO 2 FLOORS) CONTRACTOR INFORMATION Contractor Name: Keith L Clarke Business Name: Hampton Bay Homes Inc Business Addr: 7445 Somerset Shores Ct City / State / Zip: Orlando, FI 32819 Block: 1 Automatic Sprinkler System? No Fax Number: REVIEWS AND COMMENTS Review Tvpe Status Reviewed By Date Started ADDRESSING ASSIGNMENT COMPLETE Lydia Galbraith 812012015 Comment: DOCUMENTS MISSING 8/28/2015 Comment: ENVIRONMENTAL REVIEW Comment: FRONT COUNTER REVIEW Comment: PLANS EXAMINER REVIEW Comment: 9115/2015 Comment: 9/15/2015 9/15/2015 Comment: Comment: 9/15/2015 PENDING Lashahna Ingram VEG PERMIT IN DRAWER FILED UNDER "P"PARDILLO COMPLETE Ben Balcer 8/1912015 COMPLETE Lashahna Ingram 8119/2015 INCOMPLETE William Durden 911512016 Email: Keith@Phcenixcompaniesfl. Com Date Completed Date Released 8/2412015 8/24/2015 8127/2015 812MOIS 8119/2015 8/1912015 • PLEASE FURNISH ENEGRY CALULATIONS AND MANUAL J IN ACCORDANCE WITH SECTIONS 402 AND 403 OF THE 2014 FLORIDA ENEGRY CODE FIFTH EDITION. NOTE ONLY; ENERGIES MUST HAVE ORIGINAL SIGNATURE OF PREPARER • PLEASE FURNISH THE MANUFACTURES TRUSS PLACEMENT DRAWINGS IN DUPLICATE REVIEWED AND APPROVED BY THE DESIGN PERSON OF RECORD IN ACCORDANCE WITH 61G15-30.005 OF THE FLORIDA ADMINISTRATIVE CODE • PLEASE FURNISH TRUSS ENGINEERING IN DUPLICATE PER 107.2.1 OF THE 2014 FLORIDA BUILDING CODE • PLEASE FURNISH EITHER THE ICC EVALUATION REPORT OR A EVALUATION REPORT FROM A CERTIFIED TESTING LABORATORY THAT FOAM INSULATION MEETS THE REQUIRMENTS OF SECTION 316 OF THE 2014 FLORIDA RESIDENTIAL CODE t Property Card Site Address: 3869 N AlA Sec/Town/Range: 23/34S/40E Map ID: 14/23S Zoning: HIRD Ownership Tarpon Flats LLC 277 Royal Poinciana Way #156. Patin Beach, FL 33480-0000 Legal Description WATER COMM SEWER RES METER SZ. M/F IRR $ l trL.� p SECURITYDEP SERVICE FEE SAME DAY FEE OVERTIME FEE METER INSTALL.' CFC/WATER FPUA CPC CFC/SEWER GUAR. REV. LATERAL $ TOTAL CUSTOMER SIGNATURE NAME OF SPOUSE Property Card Property Identification Parcel ID: 1423-666-0022-000-1 Account #: 177752 Use Type: 0000 Jurisdiction: Saint Lucie County 4AME kCCT. # iERVICE ADDRESS rrnnrVTCrr1N I�u./��L LOT-0-13 BILLING ADDRESS PHONE #57n�29�-590 U MOVE IN/CLOSING DATE Page 1 of 1 This application hereby request and authorizes the Utility to render water and/or sewage disposal services to the premises described above in accordance with the Utilities present or future rates, rules and regulations, which by reference are made a part of this contract. Applicant agrees to pay tileUtility OMERS DEPOSITS ARE NON NEGOTIABLE OR TRANSFERABLEs and regulations. CUSTOMERS SOCIAL SEC/�� �goa 99aa FED ID SPOUSE SOCIAL 'Z- //� orrtc); use otvLYf/ a�/'} RECEIVED B t DATE RECEIVED Q CASH „cvcu tu Me currect ar rnts nme our It is suo/ect to change and is not warranted. © Copyright 2014 Saint Lucie County Property Appraiser. httn•//vAvw.naslc.ore/RECard/ 4/13/2015 JOSEPH E. SMITH, C:.rm,K OF THE CIRCUIT COURT — SAINT -•'IE COUNTY FILE # 4094884 OR BOOK 3771 PAGE 111, Recorded 07/24/2015 at 11:20 J Record and Return to: Oceanside Title a. escrow 3501 Ocean Drive Vero Bosch, PL 32960 (772)134.0700 phone (772) 2344200 faosimilo File Numberl 131504049AN Permit Numbers NOTICE OF COMMENCEMENT The undersigned hereby gives notice that Improvement will be made to certain real property, and in accordance with Chapter 713. Florida Smooths, die following Information is provided in this Notice of Commencement. I. Description of Proportyt Lot 19, Tarpon Flats Subdivision, as per plat thereof, recorded in Plat Book 69, Page 27, of the Public Records of St. Lucie County, Florida. Tax Folio Numbart 1423.566.0022-000/1 2. General Ducriptlon of Improvoments: Consmuction of single family residence together with any and all improvements 3. Owner lnfor am"orn a. Name and Address: Armando A Percilln Jr, and Mmuchis V. Pardillo b. Interest in Property: Fee Simple Names and address office simple title holder (if other than 4. Contrector'e Nano, Address and Phone Number: Hampton Bay S. Surct)as Nome, Address and Phone Namber and Bond Amount: too 6. Lender's Name, Address and Phone Number; Marina Bank and Trust Company, 571 Ranchland Boulevard, Vero Beach, Florida 32963, 772.231.6611 7. Persona within the Stare ofFlorldn designated by Owner upon wham not{cu or other documents may be served as provided by Section 713.13(1) (a)7., Florida Statutes: Nnme, Address mid Phone Number: S. In addition to himself, Omer des ignmes the following persons to receive a copy of the Liencies Notice as provided in Sec11 713.13(1)(b), Florida Studies: Name, Address and Phone Number: 9. Expiation date of Notice of Commermemem(the expiration dale is l year green dale nfrecording unless a different dote is specified): 30 days his Issuance once tificate of Ocamponcy. Mexce ee 'ar o State of Florida County ofindlan River t 'Me foregoing instrument was acknowledged befbrome This ]t�deytpfJN 2b5 by Armando A Pardiilo Jr. and Mercedes V. o, who are known m troorwho did V011fi IJ1�Vers L C,eQS(;(Si personally provide _as ofNorary Public: A, HORNwwaaumm�aasm T—y-1-tC11.=1jasftm PA3PCMAlIOaNtY WFaaaS10.V1EE1 '�+arame Expires: i- o GC Under penalties ofpujury, I declaration I have read the foregoing and that the mots in it are Iroc to the beat army knowledge and9 belief(Seotion 92.525, Florida Statutu). LL 0 S-�tgvnt'�vru(50 vvw s)or Owner(n)'MrtM1orixod OfflcerlDiroMor/Partnor/Manugerwho sfv�.n �bov+,o: 4 BY: fl/s'n" D �. //,.o/idJ �/�. By:-[ t! r/ 7-ux Florida Power & Light Company e Apri129, 2015 St. Lucie County Building Deparment 2300 Virginia Ave Fort Pierce, FL 34982 Re: Tarpon Flats - Electric power is in the entire subdivision for all new homes. Dear St. Lucie County Building Department: Thank you for contacting FPL early in your planning process. At the present time FPL has sufficient capacity to provide electric service to your property. We have facilities currently available at this location. Please advise me early in the planning process once the final plans have been approved. This information will help us to provide you with the best service in accordance with applicable rates, rules and regulations. You may also respond to us through www.fpl.com. Please contact me if you have any questions. Sincerely, Melanie Wildrick Associate Technical Specialist A NEXTera ENERGY Company k i Silo �y)' Y� 1 sT LUCI LITIES DEP , 2300 VIRGINA AVE FORT PIERCE, FL 34982 08/19/2015 13:4221 CREDIT, CARD VISA SALE CARD # WDO{1X=6805 INVOICE 0009 SEQ #: 0009 Batch #: 000214 Approval Code: 019820 Entry Method: Swoed Mode: Onlhe SALE AMOUNT „ $176.3 CUSTOMER COPY Soil Treatment I solt� aal� PropertyTreated 3' N City kav-�- p�erc� Lot# I C 1 Block Subdivision �1G15 Technician Date Treated � nm Time Product Used 110�`ld�i of Concentration 0 ,-15' # of Gallons Used $� Cmll Under Slab Slab Abutments Perimeter Treatment Comments: TERMITE HULETT environmental services 1-800-285-7378 • Pest Control • Lawn Spraying • Termite Control zub► *.d A,/L PW/ DAk&,=iva �►e,e f� PROOFED "Pest Control's Finest" APR-R90/2%YWED 01:44 PM PAX No, P. 001 B-nY41]@9 Pre -Construction Termite Treatment 7670 Okeechobee Blvd., West Palm Beach, Fl. 3341 Phone; 1-800-285-7378 Fax: 561-684-012 Property Information Builder/Contractor TzoatmentDate 7tne `% l I Lot �( Block Name of Builder Tc��on F1�IS eam, S'GC ISOR SubdivisionName � 3g,s1 lul7esidc , Construction e ' ❑Monolithic ❑Floating/Stemwall ❑Patio StreetAd&ws (If known) &,Rg- P�,� �C City state zip ORntry ❑Driveway ❑Other: _Owner's Name (If known) Product/Treatment Information ,,/ Treatment Type: ❑ Underslab ❑ Patio/Driveway/Entry ICI FInal ❑ Wood Treatment ❑ Bait System ❑ Other Product: ❑ Disodium Octaborate LL ❑ Cypeimethrin ,17r�midacloprid Dd�"©Bifenthrin ❑ Permethrin ❑ Other: Concentration •0S' Mixed Product Applied S Square Feet Treated Linear Feet Treated /il ✓' ff'�If this box is checked, then Final Perimeter treatment has been completed and the following statement is applicable: Certificate of Compliance: This building has received a complete treatment for the prev, tion of subterranean termites. This treatment is in accordance with the laws and rules establisN d by the Florida Department of Agriculture and Consumer Services. (A I IKD cji p/(blown Applicator's Name (please print) Applicator's Signature HEa-TM19 OV14 HalatEcviionmentalS iW42015 APR/C20/2GYWED 01:44 PM Aduk FAX No, P. 002 Radio Dispatcl FINAL1124-Hour Service" Corporate Center P.O. Box 220928, West Palm Beach, FL 1-800-285-PEST (7` CERTIFICATION OF PREVENTIVE SUBTERRANEAN TERMITE TREATMENT Owner Lot Block Bldg.# Sub-Divison 19 SheetAddross TARPON FLATS City 3931 DUNESIDE DR General Cont2ctorFORT PIERCE, FL 34949 Sub CentractOr USI CONSTRUCTION SERVICES, LLC Da 04/04/16 ACCOUNT #538312 — CUSTOM HOME — FINAL COMPLETED During the term of your service agreement, any further treatment necessary due to infestation of subterranean termites (includingFormosanTermites) will beperformed free ofcharge. Any structural damage neossitatingrepaus (up to 1,000,000, see details on subterranean termite service agreement) that is caused by the subterranean termites (Redwlitermes 8avipes, Retioulitermes virginicus, Reticulitermes hageni,.Prohinotermes simplex, Coptolzmam fornosanus-Formosan I emtite and Coptotermes gestmi-Asian Termite) excluding Nasutitermes costalis ('ll'eeTermite) will be paid for by Hulett F.n imamental Services. Hulett Environmental Services will annually reinspect the property oOly at vomr MQuest The SeMa agreement term shall be one (1) year from the initial date of treatment. The homeowner shall have the option of extending the service agreement annually (after the first year) for no less -than four (4) additional years with navment of annual renewal fee. Please contact our office for further details.r2�a , Your agreement covers all materials, labor, and service needed to control an active infestation of subterranean termites including Formosan Termites. A service agreement holder can request consultation and advice concerning termites or other pests at no additional charge. This service agreement is transferable to the new owner should the property be sold. Hulett Environmental Services must be notified in writing of new ownership of the property. Your service agreement has a $0.00 deductible. Should you require any additional information, please contact our termite renewal department. This building has received a complete treatment for the prevention of subterranean termites. Treatment is in accordance with rules and laws established by the Florida Department ofAgriculture and Consumer Services. MTIFICATIONSIGNE g www.bu s.com NPS Mft 0BIIIa%1 e The undersigned follows: TION INSTALLATION CERTIFICATE has BLOCK: property as t. Exterior C85 Walls have been insulated with ............................ Check one O Spray on cellulose to a thickness of NIA Inch which thickness, according to the O Fiberglass blankets manufacturer, Vl�-��yy 'tElf^Aluminum Foil Density N/A will yield LQkJV1alueof 41 (( 3 Mold Exterior.Frame walls have been Insulated with ........ .......,.Check one ( ) Spray on cellulose to a thickness of inches, which Ibicknoss,.accordingtothe ( )F.iberglass.blankets manufacturer, ( ) Aluminum Foil 'Density NIA.... willyieldan"R"value of ("): Other Splay.Foam 2. Mein Ceilings have been insulated with ........Check one ,(°) Fiberglass blankets to a thickness oq he which a ccor i to the O Fiberglass loose fill manufacturer, 3 1 ( )Aluminum Fail Density NIA willyel a^ "v� (') Other li l Ceiiirgs Whadhil have been insulated with ...4Check one ( ) Fiberglass blankets to a thickness of ditches, which thickness, according to the ( ),Fiberglass loose rill manufacturer; OAluminum Foil Density" N/A will yield an "R" valueof ( )other cobloso 3. Interior knee walls have been Insulated with. ......... ......Check one, ( ) Fiberglass blankets loalhicknessroFr� l�t I nches,.w,4, hickness,accoMmgto he OPolyurelhane manufacture , J 11 ( ) Spray ou cellulose "Density N/A wit a ' u qL-. (5 Vj�Iher Sprey Foam 4. Garage partition walls of conditioned living areas have been Insulated with..::.. to a thickness o I ..... ....... ...............Check one, inches which thickne ,According tothe f ) Fiberglass blankets ) Spray on cellulose mnnufacturer,t hO ( Density NIA 4 i ytel an R" aloe of ' O Polyurethane O Other Aluminum Foil MULTI FAMILY RESIDENTIAL CONSTRUCTION ONLY: The common (party) walls. separating different tenants shall be insulated as follows - F'rame/Metal"stud walls R,1I (Mih,), CBS or Conerete wells R-3 (Min,); by Energy Code requirements. See Energy Code Rev,1/87, paragraph 903.2(b); on page 9.17, latest edition. These "minimums levels of Insulation" are not. included in the Energy Calculations,'bubshall 'beInstalled in -the field. NOTE: Densities of sprayed, oil,, loose fill, orany other composed -on, site Insulation shall be tile'P.C.F. (Iblft3) average of -three (3)"DRY SAMPLES" ofachtai Ir„�stallatii)n; , Michelle Richards ''Insulati oonn^^����pC.00nntractor Insulation` C actor's CCI Builder's Name • Bulider's CCff I NotNoIdy Pub U 0 Planning & Development Services Building & Code Regulation Divislon 2306 Virginia Ave ,Fort Pierce; FL 34982 772-462-2165 Fax.772-462-6443' Request for 3o-Day Temporary" Power Release(? ry Date: " - aD> Perm(t Number: Project Address: c ��filctc IZ." 1. This temporary power release )s requested for, the above stated Purpose-oniy„and there will be,no pcbul5ancyof anytype, othgfIthan thatpetmitted by construction, during this time period. Z. As witness by our signatures, we�hereby agree to abide by -all terms,and conditions of thls;agreemer induding guliding;Division Policy, whlch'Is lnoorporated�herein by'reference. 1 All cpnditfons and requirements listed in the�attaehed documenteptiyed,"Regglremenis,for-30 Pay- Powerfor Testing" have beenfutillied'and the premise isreadyfor compliance Inspectlon, 4. Ali requests for an,exteinsion beyond 30 days must bemade In writing to the'Bullding:Offlclal stating the reason for ttie request., 'Power may be removed'from the site and/or. a'Stop Work Order issued 1 the Final Inspection has not been approved,withIn 30 days. A fee of $100 OOWII be, required to lift IA/i fzvrr CCvti�' Su- n o 01erei,)t � ins p ec- I' D r3 RECEIVE) MAR 16 2016 YZ 0� , 01 ".; ';l"' ';Cl ('au �y I"Nk —1")o F V� 4 1 D-(i it 4i:tf FO-k .1, 1 k2L. C CIMCM , Xt -82 -8 "'L 5 .69-3-115 7 J. ki I R, iy s,4 't "1J :YPQ 'fj" 'jj 7lj D- _Order Code/Date ? umber L 80a, 0'/27 �15 S 7L -,- tj 34018448 Due On Job: Siumin 5. o0 Truck Number. DIN. Number Ng I Driver Name -BELL, End Use: B LDNG 12 lloo2487 JANTRONY .......... . Cut k —.1,13warge llol -- -,WATERADDEDGAL— YARDS It.4 DRUM: k i—L' , WHENADDED. I- j SIGNATURE —"g4-,',e %'?',1:,Plscr,�;i;CURB�LINECRbSSEDATOWNERYSIAGENT!S:REQUEST: CONCRETE DISP L FEESIGNATURE �.'-',"J,&�OAD WAS TESTED BY P I � 11.1 � ;' ,,, Notice: Our drivers will make awry effort to place materials where thfi c�mr�cwn risk., lfwater Is added onjob, concratc, strength JAP;C Company assumes no nostaonsIbility br damages inside curb or property line. Customer agrees to the ISM onger guaranteed. WARNING: Product may 66useaG - hmdl6reje'IrKtadon. CAUTION:'Uatedal : .68UNIVERSAL PREV TPK LOAD at �i�Oqlj "�Adib.'G Al U �A 7 fit it - S. tO 6 `4 J, i - � i'i' f '2 2,4 018598 Um TNck' �Llb,17 Driver Number Driver Names 0'saLijAJ End Job-. SWP: c7 t, PRORUCTjQN DESCRIPTIONS QUANTITY VUANTITY QUANTITY 777 74 ��'y, 4 V m f OU'; Iz -9 kw- ',�LWW' 'it' I Z�44t' 2 Z��fll W "'ce, pw ':"j, n M 161 TZ' n)v- RDS'j'NLDRUM': �WHEN ADDEDISsI m, 0 6UKB UNE CROSSt[) AT OWNFR'SIAGENTI REQUEE n CONCRETE DISPbSA �.rEr---' ...... .... .. ;RqRT 'IAL, _.�,,FULL,LOAD, &IOADWASTESTEDBy: i tenon; of saie ana S. control after deliver returned concrete. �within one business ;epts concrete as 1& Due to important factors wn'On a. e wilt not accept any responsibility for the flnrshed results KeelVailef) ons and claims shalt be dearrj6dLwarved unlessin I ads to us I in m , fing calpt of Materials. I RK: 1'002,j28—!�Pni 68UNIVERSAL INVOICE IRD NUM SLC- Is-og,Dz87 YZCC-MC-X' 58269106 I `Plant: >' Begin Loa"dmg, `^To Job, , ,'i, , rArrrve''`Job �r; Stan UnlQad�<,'v Flnis6Unload�, �r,Leave"�Job �;• Return Plant ; " r Customer Code: Customer Name: ` ;Customer Job:Number.. '�. .,-Order Code/Date:. , 30,2035 (ISI CL1Nt,-CRUC`(ION SERVICES IY,L11 _ 692 10/14/15 Project Cade: °'Project Name% d ;•, Project P.O. Number. P.O Number; hOttrder O PO Mn. Ticket Date DeliveryAddress:'. - �•r+t ~ Map Page; Map/Row/Column: 1t}l14115 3931 DLJNESIDE DR. N. HUCHISON ' ISLANI "°, Deliverydnstructlomr Dispatcher: TARPON F-J-ATS // VNQM VEERO -- Tn" 1 7 f 1 STf EET GRIOGG, HEAD , rfeborbotio ','-aWTH ON A1Aa 1-13 ' FOR FLAG- AND SIGNS FOR TARPOIN ! 4LAT8 i.vidNumber. ,ON THE RTVERtiSIDC, IF YOU PAI;IS $EAL IIUSLxUN YOLIVE GONE TOO rnR L■ 33C3941.24 J Due On Job: Slump: Truck Number: Driver Number. Driver Name: - End Use: 0$ .::I) 5.00 100'c"'4•$'7$ I043813 ANTHONY N,E:LLY UNASSIGNED LOAD QUANTITY CUMULATIVE QUANTITY ORDERED QUANTITY MATERIAL CODE PRODUCTION DESCRIPTION +.. 'UOM UNIT PRIG AMOUNT 10e 5o 'i its µll.l G3. 00 1557776 3000 REG YD3 114,Ak; -:_1 . 10 00 124:73U3 FLIEL SURCHARGE 1.00 12 pE743, ENVIRONMENTAL CHARGE Cash Check p/Auth Code: , 'Signature of Diver Receiving Cash: Cash Received. Total COD Order Amount to Collect Without Standby Charges: Check Charge Comments: 'f WATERADDEDi GAL YARDS IN DRUM: WHEN ADDED. SIGNATURE CURB LINE CROSSED AT OWNER'S/AGENT'SREQUEST: CONCRETE DISPO FEE ffvvvV// (� SIGNATURE, PARTIAL FULL LOAD �/ YARDS "- —' I] LOAD WAS TESTED' BY: 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., Afwater is added on job, concrete strength Company assumes no responsibility for damages inside curb or property fine. 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 information; and to the material safety data sheets for additional information. returned concrete. Buyers exceptions and claimsshall be deemed waived unless made to us In writing 'AUTHORIZED SIGNATURE: within one business day after the receipt of.. materials. 68UNIVERSAL. PREV T 131%e INVOICE LOAD NUM:. t This Delivery Ticket, incorpor s herein by reference Buyer's previously e cuted Credit Application, if any, Seller's Standard Terms and Conditions, SellerlWtation, if any, and Seller's Order'Confi n (including limitations of warranties), -as if fully set forth on this Delivery Ticket Agreement"). Seller will provide the Stand 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 th can cause eye irritation, skin and eye burns and allergic skin reactions. Dry concrete and aggregate dust,may, p'se irritation to eyes, skin, and/or respiratory tract. Dust from handling, crushing, grinding, cutting and/o7 dril, bg may contain silica, which may cause silicosis and cancer if inhaled. If ingested, keep warm, at rest, an rik large amounts of water. Fly Ash may contain trace amounts of ammo- nia. Moisture can cause the ammon(o be released. Inhalation of ammonia can cause coughing and irritation or burns of the nose, throat and lung 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 V7combined Houston, Texas 77024 02/12 For more information please visit www.cemexusa.com. Este ticket de entrega inc]uye como referencia al comprador (ya previamente ejecutada en su aplicacift de cr6dito); cualquier t6rmino estandar, condiciones del vendedor; propuestas del vendedor y orden de confir•maci6n del vendedor (con limitaciones y garantfas), como acuerdo total del ticket de entrega ("Contrato"). El vendedor proveera los t6rminos estandares y condiciones detal- Jades 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 cl monto de acuerdo al contrato; al menos que se identi- fique con una nota al frente de este documento. /c;rivENTO/ 1110 Los productos de agregados son materiales naturales como piedra caliza, dolomita, granito, roca volcanica, arena, grava y otros materialessilicios. Los productos de cemento incluyen Cemento de tipo Portland, de albariilerfa, pozzolan (tipo IP), 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 coal 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 reacciones al6rgicas en la piel. Concreto seco y polvo de agregados, pueden causar irritaci6n en los ojos, piel y/o en la zona tespiratoria. Polvo del mauejo en el trituramiento, pulido, cone y/o perforacion puede contener materiales silicos, Jos cuales pueden causar silicosis pulmonar y caancer 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 liberaci6n del amoniaco. La inhalaci6n del amoniaco puede causar toser, irritaci6n o quemaduras en la nariz, garganta y pulmones. Acudir inmediatamente a] medico. El riesgo en ]a salud depende cn la duraci6n y el nivel de la exposici6n. Seguridad: Evite el contacto con ojos y contacto prolongado con la pie]. Use guantes, protecci611 en los ojos yropa Primeros adecuada para protecci6n. Lhvcse las mars con jab6n suave y agua despuds del mauejo de materiales. Evite inhalar auxilios: pelves. Si se expone a polvos mas de los limites recomendados, use protecci6n respiratoria. Primeros auxilios: En caso de contacto en Jos ojos, inmediatamente fluya agua en la parte afectada per 15 minmos. Si se inhala polvo, exp6ngase a aire fresco. Si el cemento fresco tiene contacto con sus ojos, lavelos a Tondo con agua. Acuda a atenci6n m6dica inmediatamente si la irritaci6n continua. CEMEX, Memorial Hermann Tower 929 Gessner, Suite 1900 V7 combinado Houston, Texas 77024 02/12 Para m6s infornaci6n visita www.cemexusa,min. SZC- 02-97 w -0. Plant: Beg1n Loading: 'iTo Job =, "• " `�' ArrrveaJob ' S;Start`UDload�"+ "s` Fimsh(Unload r `"' Leave�Jo6 '" Return Planti'o •+ oT..i / 1093 I ,. Customer Code: 'Customer Name: Customer Job. Number. 3o_ta�s 1sz µraNSTRI_Icra:aN sERuiCEs� L.LC `Project Code. Project Name: Project P.O. Number: Ticket Date: DeliveryAddress:. 10/14/15 3931. DUINIESME DR. N. HUCHISON ISSI.AND Delivery Instructions: IARPON FLA.M 1/ Fi\UM TrilT 17TH STPF T AR1.1.DOEqHEAD SOUTH Gil I f t. 1..1C31: Fttl ik I `_f t'ii;`JI} v 7.Izhi FOR 1"t�Tzf phi 1=1,. 11 ,r, C7# 'iHE Ri'Jrk s JaL'. ig YOU Pflriri STAI, itOSEU111 Y+OUVE= CONE TOO PAR 'Omer Code / Date:- 69 : I _+/ 14,115 Order P.O. Number;, NO PQ Map Page: Map/Row/Column: Dispatcher:' Ci B ca r)'r"k.>3 fl tit Ticket Number: 33994194 Due On Job: -Slump: Truck Number: DriverNumber. Driver Name: End Use: 08.. 36 5.f?l)". '. ( :'.11'w264UL� 109519 [�( } (� 1HOMAS BALLING _ UNRSSTGN LOAD 'QUANTITY CUMULATIVE I QUANTITY ORDERED '. QUANTITY MATERIAL'CODE PRODUCTION DESCRIPTION UOM UNIT PRICE AMOUNT 10.50 / .�_ri0 L..ua 00, l557 6 arf l()0 REG YD- 1in 1, 00 1-47w31'Fi FUEL SURCHARGE 1.00 ,7 7k ENV I RaNMENTAL CHARGE Check WATERADDED: GAL YARDS IN DRUM:_ TWHEN ADDED. CURB LINE CROSSED AT OWNERS/AGENTS REQUEST: C ONC.RLTE DISPOSAL FEE PARTIAL FULL LOAD YARDS SIGNATURE '—"—" —"— ❑ LOAD WAS TESTED BY: Notice:. Our drivers will make every effort to', placematerials 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 ds nolong. nguaranteed: WARNING: Product may cause skin and/or eye Irritation. CAUTION: Material' terms of sale and delivery and accepts concrete as le. Due: to Important factorswhich am 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 Me finished results. No credit for 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 to us in writing. AUTHORIZED SIGNATURE: within one business day after the receipt of materials. O 11r 88UNIVERSAL PREY TRK. 10024878 INVOICE � LOAD NUMB r_. This Delivery Ticket incor'or,+ s herein by reference Buyer's previously ex cuted Credit Application, if any, Seller's Standard Terms and Conditions, Seller a )tation, if any, and Seller's Order Confi#bn (including limitations of warranties), as if fully set forth on this Delivery Tickett�7r\r greement"). Seller will provide the Stan . Perms 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. AGGKL+'GA'M / UL1VIEN1' / Aggregate products are naturally occurring materials including siliceous materials. Cement products include Portland cemei products include Portland cement and aggregate products inch other siliceous materials. These products, including fly ash, in; 1"K0UUU1'S / FL dolomite,granite, volcanic rock, sand, gravel, and other y, pozzolan (Type IP), roof tile, and stucco. Concrete >tone, dolomite, granite, volcanic rock, sand, gravel, and 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 1.5 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 come referencia al comprador (ya previamente ejecutada en su aplicaci6n de crddito); cualquier termino estandar, condiciones del vendedor, propuestas del vendedor y orden de confirmaci6n del vendedor (con limitaciones y garantfas), como acuerdo total del ticket de entrega ("Contrato"). El vendedor proveera los t6rminos estandares y condiciones detal- lados on 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 mcnos que se identi- fique con una nota al frente de este documento. AGKhkiAUUJ / / YKVVUI 1Ub UE+ UU1NUKEIU / 1 E+NlGAN Los productos de agregados son materiales naturales como piedra caliza, dolomita, granito, coca volcdnica, 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 inctuyen cemento Portland y productos de agregados como piedra caliza, dolomita, granito, coca volcdnica, arena, grava, y otros materiales silicios. Estos productos inchiyen ecnizas 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 irritati6n en los ojos, quemaduras en piel y ojos, y reacciones alergicas en la piel. Concreto secoy polvo de agregados, pueden causar irritaci6non los ojos, pie] y/o on la zona respiratoria. Polvo del manejo on el trituramiento, pulido, torte y/o perforaci6n puede contener materiales silicos, Jos cuales pueden causar silicosis pulmonar y cancer si son inhalados. En caso de set ingeridos, mantenerse on temperatura calida, reposar y tomar grandes cantidades de agua. Las cenizas volantes pueden contener amoniaco. Seguridad: La humedad puede causar la liberaci6n del amoniaco. La i.nhalaci6n del amoniaco puede causar toser, irritati6n o quemaduras en la nariz, garganta y pulniones. Acudir inmediatamente al medico. El riesgo on 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, proteccion en los ojos y ropa Primeros adecuada para protecti6n. Lavese las manosconjab6n suave y agua despuds del manejo de materiales. Evite inhalar auxilios: pelves. Si se expone a pelves mas de los limites recomendados, use proteccion respiratoria. Primeros auxilios: En caso de contacto on los ojos, inmediatamente fluya agua en la parte afectada per 15 minutes. 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 ]a irritaci6o continua. CEMEX, Memorial Hermann Tower 929 Gessner, Suite 1900 V7 combinado Houston, Texas 77024 02/12 Para mas informaci6n visita www.cemexusa.com. SAC _ 02 t�7- ccmcx r n T ft y-t r 58267846 Plant:,-,-%;j, ?, Return Plante'`,; ,BegtnLoading, z+rl,,ToJobs�'Arrrve"Job ,'-Star[Unload*,wFmsh;Unload,Leave"°Joti .y �fi Customer Coded Customer Name:. Customer Job Number., Ztinatc20O 3.... UST, P.]lUT�.r-'TRUCTION SERVICES 1,L1' Project Cotle; 1; Proect Name: Project P.O..Number. Ticket Date: 'Delivery Address: l oedverylnUo^s: 39331 DONESI. E DR, N. HUCHISON ISLAND - TARPON-.L.AT6"a / / F-ROM VtRf3 • TAKE, 17TH STRtET' SRII QE, HEAD SOUTH ON AIA, +..OQi' FOR FL.MiS AND SION 4 FOR TARPON FLATS ON THE Rlri 'ERSIIDE. IF YOU PASS SEAL MUSEUM YOU'VE GONE TOO FAR' r Order Code / Date: qq 4r,,/ 6,2, r ,0 Numti Uf 1.J- Malp Page,' MaeRow/Column: Dispatcher.. DCSEAf+1S Ticket Number:' 33994223 i Due On Job: Slump: Truck Number. Driver Number: - Driver Name: End Use: at5 5.t�U 7i5Oc57C5 1<l9'c't]6 fARIO STINSON UNASSIGNED LOAD CUMULATIVE ORDERED 9 ° �,) MATERIALCODET' PRODUCTION DESCRIPTION UDM UNIT PRICE 'AMOUNT QUANTITY ..� _QUANTITY, QUANTITY r p it�.5O ;;1aGlrs 63.00 17,57776 3000 RES 1.00 124` 81.8 FU17-L SURCHARGE 1.00 E ?U74c•9 ENVIRONMENTAL CHARGE V Cash Check #,FAuth Code: 'Signature of Driver Receiving Cash: Cash Received: To at COD Order Amou^tto Collect Without Standby Charges: Check Charge Comments: 1 tWATER ADDED: / (/ GAL YARDS IN DRUM: WHEN ADDED. ETE DISPOSAL FEE PARTIAL FULL LOAD _- YARDS CURB LINE CROSSED AT OWNER'S/AGENT'S REQUEST: k ❑ LOAD WAS TESTED BY SIGNATURE Notice: Cur 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 guaranteetl. WARNING: Product may cause skin and/or eye Irritation. CAUTION: Material terns of, sale and delivery and accepts concrete as Is. Due to Important factors which am 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 information, and to the material safety data sheets for additional Information. returned concrete. Buyers exceptions and claims shall be deemed waived unless made to as in writing AUTHORIZED SIGNATURE: within one business day after the mcelpt of materials. O ,%PrtM l? 68UNIVERSAL 11IT161 LdJ This Delivery Ticket incorpor s herein by reference Buyer's previously x uted Credit Application, if any, Seller's Standard Terms and Conditions, Scller tation, if any, and Seller's Order Corffi n (including limitations of warranties), as if fully set forth on this Delivery Ticke Agreement"). Seller will provide the S an d Terms and Conditions upon request. Buyer agrees that, unless otherwise noted on the front hereof, all quantities and items ere delivered as indicated and further expressly agrees to pay in accordance with the Agreement. AGGREGATE / CEMENT / CONCR"E 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 NIOSH-approved respiratory protection. Mrst Aid: In case of eye contact, immediately flush eyes with flowing water for 1.5 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 comp referencia al comprador (ya previamente ejccutada en su aplicaci611 de cr6dito); cualquier t6rmino estandar, condiciones 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 los t6rminos estdndares y condiciones detal- lados en caso de asf ser requeridos. Con este docurnento, 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 at contrato; at menos que se identi- fique con una nota al frente de este documento. GIV] Stf illc7:1f101%XL" Wk7_I_ink:51 LfJ I I] DI V Vl,AIV'1'EN Los productos de agregados son materiales naturales como piedra caliza, dolomita, granito, rota v,olcanica, arena, grava y otros materiales silicios. Los productos de cemento incluyen Cemento de tipo Portland, de alban"ilerfa, 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 volchnica, arena, grava, y otros materiales silicios. Estos productos incluyen cenizas volantes (fly ash) la cual puede contener mds de 0.025% de silicio cristalino. Peligros: Mezcla de cemento fresco y/o cenizas volantes pueden causar irritaci6n en los Ojos, quemaduras en piel y ojos, y reactions aldrgicas 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, cone 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 tomargrandes cantidades de agua. Las cenizas volantes pueden contener amoniaco. Seguridad: La humedad puede causar la libertci6n del amoniaco. La inhalaci6n del amoniaco puede causar toner, irritation o quemaduras on la nariz, garganta y pulmones. Acudir inmediatamente al medico. El riesgo en la salud depende ell la duraci6n 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 manor con jab6n suave agua dcspues 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 inhalapolvo, exp6ngase a afire fresco. Si el cemento fresco tiene contacto con sus ojos, lavelos a fondo con agua. Acuda a atenci6n m6dica inmediatamente si la irritaci6n continda. CEMEX, Memorial Hermann Tower 929 Gessner, Suite 1900 V7 combinado Houston, Texas 77024 02/12 Para mas informacion visita www:cemexusa.com. tl C G M G X i Planf: Begin Loading �4To Job r,,., �,Arrge'Job `„ , �,Sfart,U,nload Fmish`UNoad afl.eave�Joti 'IW� Return Plant ; S: Customer Code: Customer Name: I it Customer. Job Number.: 022035. .!iS1.. =f N^aTRiJCTSCiV ^a RYICE,(3 t,LC Project Code: _. •'•Project Name;, 4 Protect P.O Numoerr x Ticket Dater Delivery Address:. 1f7/14/15,_ ;931 DUNESID{= DR. N. HUCHLSON ISLAND Deliverylnsimctions TARPOti FLATS . x" FROM VL RO TAKE 17 T H STREET BRIDGE, HEAD SOUTH ON PIA, L-001J, FOR FLAGS PN4i G10filt3 L.OR TARPON FLATS, ,r Oti,t THE RIVERSIDE 'IF YOU I"ACBS SEAL MUSEUM YOUVE GONE TOO FOR Order Code /Date: 692 1Q/1L4/15 Order P.O. Number: 1140 F'C1 Map Page: Map/Row/Column: Dispatcher. DCSE£iMS_ _ I Ticket Number:' 3,3994301 Due On Job: -Slump: Truck Number: Driver Number: - Driver Name: End Use: 9c=?4 5.tyt) 1 064924 i09'202 FAY ;ORRIS UNASSIGNED LOAD QUANTITY CUMULATIVE. QUANTITY; ORDERED QUANTITY MATERIAL CODE PRODUCTION DESCRIPTION' UOM UNIT PRICE I AMOUNT 10. 0 1442. 0?) F3. 00 1557176 ,i 0oo RE:G YD3 Cash Check # /Auth 1247GIB FUEL SURCHARGE 12xDi 74t3ENVIRONMENTAL. CHARGE. 04" a 14 Ati 8:19 WATER ADDED: 2 GAL YARDS IN DRUM: . WHEN ADDED. SIGNATURE ONCRETC DL:if3OSPi.: FEE CURB LINE CROSSED AT OWNER'S/AGENT'S REQUEST: SIGNATURE PARTIAL. FUL.I_ LOAD YARDS '❑ LOAD. WAS TESTED BY: 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 artier eye imitation. CAUTION: Material terms of sale and delivery and accepts concrete as is. Due to Important factors whicham 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 information, and to the material satty-d m 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 68UNIVERSAL PREV fRK¢ 100257F5 INVOICE V LOAD NUM: 4 (/ This Delivery Ticket incorporates herein by reference Buyer's previously executed Credit Application, if any, Seller's Standard Terms and Conditions, Seller' rotation, if any, and Seller's Order Confi' n (including limitations of warranties), as if fully set forth on this Delivery Tick'WAgreement"). Seller will provide the Sia 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. AUUKEr GA'1'Lr / UL1VIEN'1' / Aggregate products are naturally occurring materials including limestone, dolomite, granite, volcanic rock, sand, gravel, and other siliceous materials. Cement products include Portland cement, masonry, ; ozzolan (Type IP), roof tile, and stucco. Concrete products include Portland cement and aggregate products including limestorT, dolomite, granite, volcanic rock, sand, gravel, and other siliceous materials. These products, including fly ash, may contain nitre 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 Bands 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.cemexusa.com. Este ticket de entrega incluye come, referencia al comprador (ya previamente ejecutada en su aplicaci6n de er6dito); cualquier t6rmino estandar, condiciones del vendedor, propuestas del vendedor y orden de confirmaci6n del vendedor (con limitations y garantfas), come, acuerdo total del ticket de entrega ("Contrato"). El vendedor proveer'a los t6rminos estdndares y condiciones detal- Jades en caso de asf ser requeridos. Con este documento, el comprador acepta los mismos ya antes mencionados y que las cantidades y materiales fucron entregados coma se expresa on el mismo. Acepta pagar el monto de acuerdo al contrato; al means que se identi- fique con una rota al frente de este documento. DE UONCRETO / CENIZAS VOLANTES Los productos de agregados son materiales naturales como piedra caliza dolomita, granito, rota volcanica, arena, Brava y otros materiales silicios. Los productos de cemento incluyen Cemento de tipo Portland, de alban"ilerfa, pozzolan (tipo IP), azulejo de azotea y estuco. Los productos de concreto incluyen cemento Portland y productos de agregados come piedra caliza, dolomita, granito, rota volednica, arena, grava, y otros materiales silicios. Estos productos incluyen cenizas volantes (fly ash) la cual puede contener mris de 0.025%, de silicio cristallno. Peligros: Mezcla de cemento fresco y/o cenizas volantes pueden causar initaci6n en los ojos, quemaduras on piel y ojos, y reacciones al6rgicas en la piel. Concreto seco y polvo de agregados, pueden causar irritacion on los ojos, piel y/o en la zona respiratoria. Polvo del manejo on el trituramiento, pulido, cone y/o perforaci6n puede contener materiales silicas, los cuales pueden causar silicosis pulmonar y cancer si son inhalados. En caso de ser ingeridos, mantenerse on temperatura calida, 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, initaci6n o quemaduras on la nariz, garganta y pulmones. ACndir inmediatamente al medico. El riesgo on ]a 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 Jos ojos y ropa Primeros adecuada para protecci6n: Ldvese las manor 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 on los ojos, inmediatamente fluya agua on la parte afectada por 15 minutos. Si se inhala polvo, exp6ngase a aire fresco. Si el cemento fresco tiene contacto con sus ojos, lAavelos a fordo con agua. Acuda a atenci6n m6dica inmediatamente si la irritaci6n continua. CEMEX, Memorial Hermann Tower 929 Gessner, Suite 1900. V7 combinado Houston, Texas 77024 02/12 Para mas informacion visita www cemexusa com. t i 0 562-67349 Plant: Begin Loading: To Job: Arrive Job: Start Unload: ` Finish Unload: Leave Job: Return Plant: CustomerCode: Customer lJame:. !, ' Customer Job Number:, ' jectC.:`�11!IC't"Cflt'I'3�L ;ProjersCode:' Project Name: -- C�r, - - - Pmjecl P.O. Number. Ticket Date; Delivery Address: ^rl/I/d J:r ` 'f9— DIINIFC 11 lF 1t12, N NIIr ;i{C;0Pr 1^r, CrNIT Delivery Instructions: T l.�l r, r�;l f ! t-, f;' „i)i•I .�r'} - nl� iTl-I :. f,..-= ?',. .iic9 F4i=1Pli `-�[C.rf` f•i.i' ON ''117 L''J tIFR ,'IPi---. fF' Mtf I t='v' 'jF.L;L t4liSEl I,+' VGU'll' GONLL TOO r !"R Order Code I Data: '�)11.41)' Order P.O. Number. .Map Page't"I Map/Row/Column; Dispatcher: T fZN mbesn'�S - , 33994397 Due Ori Job. Slump: Track Number. Driver Number. Driver Name: End Use: - 9a24 :isitt') t00'257LO ;0722ri OB COL..EMAN UNASSIGNED LOADCUMULATIVE ORDERED MATERIALCODE PRODUCTION DESCRIPTION UOM UNIT PRICE AMOUNT QUANTITY QUANTITYI. QUANTITY' 1 L7. JI_I .- 'a3.,d/ � ,r � � yl ,�I:i Rt. L-'. ) u_ • 4 L _4 A,L L'Hf1R6E Cash Check#/Auth Code: Signature of Driver Receiving Cash: 'Cash Received Tota1COD Order Amount to Collect Check Without Standby Charges: Charge - Comments: n WATER ADDED: //! GAL YARDS IN DRUM: ' WHEN ADDED. 4, SIGNATURE CURB LINE CROSSED AT OWNER'S/AGENT'S REQUEST: ONCRETE DISPOSAI. FEE PARTIAL FULL LOAD YARDS SIGNATURE '^ ❑ LOAD WAS TESTED. BY: Notice: Our drivers will make every effort to place materials where the customer designates, but the SPECWLTERMS: Any water added is at customers own risk Ifwateris added onjob, 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 ancifor eye irritation. CAUTION: Material terms of sale and delivery and accepts concrete as Is. Due to Important factors which are out of out may be hazardous to your safety and health. Please refer to the backside of this ticket for important central after delivery, this Company will not accept any responsibility for the finished results. No credit for 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 to us In writing AUTHORIZED SIGNATURE:' within one business day after Me receipt of materials. O i'/ v Lr RD NUN: S 66UNIVERSAL INVOICE _ This Delivery Ticket incorporates herein by reference Buyer's previousl-•---cuted Credit Application, if any, Seller's Standard Terms and Conditions, Selle rotation, if any, and Seller's Order Con ion (including limitations of warranties), as if fully set forth on this Delivery Tic Agreement"). Seller will provide the St_____1 Terms and Conditions upon request. Buycr 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. AUUKLUA l E / UL1V1EXY / FKU1)Ul IN / VLY ANH Aggregate products are naturally occurring materials including limestone, dolomite, granite, volcanic rock, sand, gravel, and other siliceous materials. Cement products include Portland cement, m- sonry, 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 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.cemexusa.com. Este ticket de entrega incluye come, referencia al comprador (ya previamente ejecutada en so aplicaci6n de eredito); cualquier termino estdndar, conditions del vendedor, propuestas del vendedor y orden de confirmaci6n del vendedor (con limitaciones y garantfas), como acuerdo total del ticket de entrega ("Contrato"). El vendedor proveerd los terminos est5ndares y condiciones 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 pagan el monto de acuerdo al contaato; al menos que se identi- fique con una nota al frente de este documento. AbKL' kxALV.7 / Ur 1V1L' 1N 1 V / YKVLUk-I VJ LE l.ViNL Ml� IV / l,L' iNMAZ7 Los productos de agregados son materiales naturales como piedra caliza, dolomita, granito, rota volcanica, arena, grava y otros materiales silicios. Los productos de cemento incluyen Cemento de tipo Portland, de alban"ilerfa, pozzolan (tipo IP), azulejo de azotea y estuco. Los productos de concreto incluyen cemento Portland y productos de agregados como piedra caliza, dolomita, granito, coca volcdnica, arena, Brava, y otros materiales silicios.;Estos productos incluyen cenizas volantes (fly ash) la coal puede contener rods de 0.025% de silicio cristalino. Peligros: Mezela de cemento fresco y/o cenizas volantes pueden causar irritaci6n en los Ojos, quemaduras en pie] y ojos, y reacciones alergicas en la piel. Concrete 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, cone y/o perforacicm puede contener materiales silicos, los cuales pueden causar silicosis pulmonar y cfincer si son inhalados. En caso de set ingeridos, mantenerse en temperatura cdlida, 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 t•iesgo 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, protecci6n en los ojos y ropa Primeros adecuada para protecci6n. Ldvese las manor con jab6n suave y agua despu6s del manejo de materiales. Evite inhalar m auxilios: pelves. Si se expone a pelves is de los limites recomendados, use protecci6n respiratoria. Primeros auxilios: En caso de contacto en los ojos, inmediatamente fluya agua en la pane afectada per 15 minutes. Si se inhala polvo, exp6ngase a afire fresco. Si el cemento fresco tiene contacto con sus ojos, lavelos a fondo con agua. Acuda a atencicin medica inmediatamente si la irritaci6n continda. CEMEX, Memorial Hermann Tower 929 Gessner, Suite 1900 V7 combinado Houston, Texas 77024 02/12 Para mds informaci6n visita www.cemezusa.com. JYZCEMC-x 58267850 Plant: Begin F�p1"�`,r °; Arrlye`�Job Unload'` h bcave Jol s Return Plant:+ . Loading ; yTo,'Job ,a /� , ,Start ,i; FmsF Unload , �',M .Customer Code: '.Customer Name; , 'Customer Job Number. 7,,t Pjr`c(Coe Pro7ecl Name%":�r.L1, . I.0 role )tl`'7+S� Project P.O,.' Number. Ticket Data: DeliveryAddress: 1r7t-)t,fyry. ..,?n+� r�. DU:'{FSY.3F'-J'R� M. HJ01-1I�-�ON-I:it,ANn µyD.aliyyre'yry(l'n's�rWch6ns/^�,'r' p p^r` yam, (� {'., II I—iI'll�.S:�;fir ! � 4'"i l i{ +f IMf(i �i'1 44F• 44f1. :':'iL sl'e .'..,M I f'! Q1 TR E, { BR I- 4GE J 14EAD SOUTH 0111 Aal-s., i_001I , F09 FLAGC ."WI) )TONF FOR TPRPON f .:f*l`S ON THE k; 3; °aF,fdl-r { DF. F 'YOU P' AS a WfMI- xlUT'r_ON `+'t)UVE GOM? 0o rwl i Order Code / Date: OrderPA:Num5larq / 14/ 1-5 t"10 I.Map/Raw/Column; !ii Map Page: sp tc�pr.273060.1.0 Ticket Number: 33994425 Due On Job; Slump: Truck Number. Driver Number: Dever Name: End Use 5.f1C7 70t).'63,?i,' !,r)r'aGi:1!} CAVE 5IEM5 UNASOIGNED LOAD QUANTITY CUMULATIVE QUANTITY, ORDERED QUANTITY MATERIAL CODE. PRODUCTION, DESCRIPTION , UOM UNIT PRICE' AMOUNT I O. 5O f:'3- of, G3„ 00 15 ;777C, 3000 REG /I?3 1.00 12t,:721'''. FUEL SURCI-IARGF 1.00 F:NVIRONMEwroL CHARGE of Driver Recelving Cash: u (JONCRETE DISPOSAL FEE PARTIAL FULL LOAD Notice: Our driverswill make every effort to place materials where Companyassumes no responsibility far damages inside curb or prop terms of sale and delivery and accepts concrete as is.. Due to imp< control after delivery;. this Company will not accept any responsibility to returned concrete. Buyers exceptions and claims shall be deemed w 'within one business day after the receipt of materials. to YARDS IN DRUM: WHEN ADDED. CURB LINE CROSSED AT OWNER'S/AGENT'S REQUEST: _,< BARDS - ❑ LOAD WAS TESTED BY: mer designates, but the SPECIALTERMS: Any water added is at customers own risk.. If water Is added on job, concrete strength Customer agrees to the Is no longer guaranteed. WARNING: Product may cause skin and/or eye irritation. CAUTION: Material ors which are out of our may be hazardous to your safety and health. Please refer to the backside of this ticket for important led results. No credit for safety handling information; and to the material safety data sheets for additional Information. as made to us In writing AUTHORIZEDSIGNATURE: 68UNIVERSAL PREV fRK: 10025/60 INVOICE LOAD NUN: 6 This Delivery Ticket incorpe--+-- herein by reference Buyer's previously -----uted Credit Application, if any, Seller's Standard Terms and Conditions, Seller Station, if any, and Seller's Order Con!] on (including limitations of wan•anties),.as if fully set forth on this Delivery Tick-., Agreement"). Seller will provide the StauuaLu 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. AUUKLr UA l L+ / ULIVILA N l / YKUUUUIN / r'LY A�Rl 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 siliccous materials. These products, including fly ash, may contain more than 0.025% crystalline silica. Hazards: Freshly mixed wet cement and/or fly ash can caueye irritation, skin and eye burns and allergic skin reactions. Dry concrete and aggregate dust may cause irritar u 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 www.cemexusa.com. Este ticket de entrega incluye comp referencia a] comprador (ya previamente ejecutada en su aplicaci6n de cr6dito); cualquier t6rmino estandar, condiciones del vendedor, propuestas del vendedor y orden de confirmaci6n del vendedor (con limitations y garantias), come acuerdo total del ticket de entrega ("Contrato"). El vendedor proveera los t6rminos estandaresy condiciones detal- lados en case 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 que se identi- fique con una rota al frente de este documento. AUKLUAVUS / l.:Lr 1VIEN 1'U / YKUI)UU'YUS I)E Los productos de agregados son materiales naturales como piedra caliza, dolomita, granito, rota 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 concrete 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: Mezela de cemento fresco y/o cenizas volantes pueden causar irr•itaci6n en los Ojos, quemaduras en piel y ojos, y reacciones al6rgicas en la piel. Concreto seco y polvo de agregados, pueden causar irritaci6nen los ojos, pie] y/o en la zona respiratoria. Polvo del manejo en el trituramiento, pulido, torte y/o perforaci6n puede contener materiales silicos, Ins 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 liberaci6n del amoniaco. La inhalaci6n del amoniaco puede causar toser, irritaci6n o quemaduras en la nariz, garganta y pulmones. Acudir inmediatamente al medico. El ricsgo 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, protecci6n en los ojos y ropa Primeros adecuada Para protecci6n. 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 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 m6dica inmediatamente si la irritacion contimia. CEMEX, Memorial Hermann Tower 929 Gessner, Suite 1900 V7 combinado Houston, Texas 77024 02/12 Para rods informaci6n visita www.cemexusa.com. I , zzcc-mc-x 56267656 Plant: Begin "Loading: To Job?; , ,,>Artnve Job: , StaSt`Unload ' � ' Finish`UnlOadtt„ , m Leave JQb ^ iReturn Plano` 9 Customer Code: Customer Name:. Customer Job Number: Order Code/Date: v!S'22.t�35 UST CONSTRUCTION SLRIr ICf S.. LLC - _ . 692 10/ 14/ 15 'Protect Code: = Pro act Name: Project P.O. Number: Order P.O. Number. NO PO Ticket Date: Delivery Address: Map Page:. Map/Row/Column: 1Del/ery4/ t ns„ .�iu9,3t DL.Ir'�E SIDE ,(Jiw. N, �'Z.I,. CHLSSON - .ISL...AND - - 273 er•'2734$418 TARPON FLATS / FROM VERO -- IAKE 17PH STREET BIRMGE, HEAD 5GSEAMS- .. .... ., ... - .. ,,, Ticket Number: SOUTH ON A1A, LOOK FOR FLAGS MiD SIGNS FOR TARPO11d FLATS ON THE RIVERSIDE. TF YOU PASS SErAL. MUSEUM Y0,UVE GONE TOO FAR' 339951/4 Due On Job: Slump: - Truck Number: Diver Number: Driver Name: End Use:. ,q. F1': �.. I}ti i0riP .'7`-. L. i(in:TiA VRnim • I.iTI r-na II rGd„rrrJFD LOAD CUMULATIVE. ORDERED MATERIAL CODE PRODUCTION DESCRIPTION UOM UNIT PRICE AMOUNT QUANTITY CLEANTITY, QUANTITY 7. oo 70. 00 70. 00 1,557776 3C)(Cil) REE.G Yn;; QCT 14 Rmll:29 1.00 1.01) Check Charge 1"?47,916 FUEL SURCHARGE 1202749 ENVIRONMENTAL Standby Charges: WATERADDED: GAL YARDS IN DRUM: WHEN ADDED. 1 CURB LINE CROSSED AT OWNER'S/AGENT'S REQUEST: ONCRETE DISPOSAL FEE —__ PARTIAL FULL LOAD YARDS l]LOAD Notice: Our drivers will make every effort to place materials where the customer designates, but the SPECIAL TI Company assumes. no. responsibility for damages Inside curb or property line. Customer agrees to the is no longer terms of sale and delivery and accepts concrete as is. Due to important factors which are out ofour' may be haz control after delivery, this Company will not accept any responsibility for the finished results.. No credit for safety handli returned concrete. Buyers exceptions and claims shall be deemed waived unless made to us. in wiling' AUTHORIZE within one business day after thereceipt of materials. n is at customers awn risk. 1f water Is added on job, cor Product may cause skin and/or eye irritation CAUT I health. Please refer to the backside of this ticket material safety data sheets for additional information. 68UNIVERSAL PREY TRK. 10O25.32 INVOICE / LOAD NUM: 7 This Delivery Ticket, incorpo —`-- herein by reference Buyer's previously----uted Credit Application, if any, Seller's Standard Terms and Conditions, Seller >tation, if any, and Seller's Order Confi )n (including limitations of warranties) Ls.if fully set forth on this Delivery Tick.,, \ , greement"). Seller will provide the Stanuaru 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 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 www.cemexusa.com. Este ticket de entrega incluye Como referencia al comprador (ya previamente ejecutada on su aplicaci6n de cr6dito); cualquier t6rmino est6ndar, condiciones del vendedor, propuestas del vendedor y orden de confirmacidn del vendedor (con limitaciones y garantias), como acuerdo total del ticket de entrega ("Contrato"). El vendedor proveerd los t6rminos estftndares y condiciones detal- lados on caso de asf ser requeridos. Con este documento, el comprador acepta los mismos ya antes mencionados y quo las cantidades y materiales fueron entregados como se expresa on 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, roca volciinica, 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, roca volc5nica, arena, Brava, y otros materiales silicios. Estos productos incluyen cenizas volantes (fly ash) In cual puede contener m6s 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 aldrgicas on la piel. Concreto seen y polvode agregados, pueden causar irritacidn en los ojos, piel y/o en la zona respiratoria. Polvo del manejo on el trituramiento, pulido, corte y/o perforaci6n puede contener materiales silicos. Jos cuales pueden causar silicosis pulmonar y cancer si son inhalados. En caso de ser ingeridos, mantenerse en temperatura c5lida, reposar y tomar grandes cantidades de aqua. Las cenizas volantes pueden contener amoniaco. Seguridad: La humedad puede causar ]a liberacipn del amoniaco. La inhalaci6n del amoniaco puede causar toner, initacidn o quemaduras on la nariz, garganta y pulmones. Acudir inmediatamente a] medico. El riesgo on ]a salud depende en In duraci6n y el nivel de la exposici6n. Seguridad: Evite el contacto con ojos y contacto prolongado con la piel. Use guantes, protecci6n en los ojos y ropa Primeros adecuada para protecci6n. Lavese lasmanos con jab6n suave y agua despu6s del manejo de materiales. Evite inhalar auxilios: polvos. Si se expone a polvos mds de los limites recomendados, use proteccidn respiratoria. Primeros auxilios: En caso de contacto on los ojos, inmediatamente fluya agua en la parte afectada por 15 minutos. Si se inhala polvo, exp6ngase a dire fresco. Si el cemento fresco tiene contacto con sus ojos, ldvelos a fondo con agua. Acuda a atencibn medica inmediatamente si In irritation continua. CEMEX, Memorial Hermann Tower 929 Gessner, Suite 1900 V7 combinado Houston, Texas 77024 02/12 Para m5s infbnnaci6n visita vvww.cei Z-ZCC-MC-x SLC, iso9- 0z8 7 ,Lo �d 9 (LA 58259358 '_Plan$ ? Begin Loading .'',To,Job ',. Arrive?Job ';Start+Unload'f" Fimeh`URload r, "':A Leave'Job ,'ReEum Plant f39�/ 1 Q9.5 Customer Code: Customer Name: 3022035 USI CONSTRUCTION SERVICES i._LC Project Code: -Project Name: it.a:z)fm-58 ViAT—ri Aki-x q THRU VERO Ticket Date: Delivery Address: 10/27/15 TARPON FLATS LOT 1,9 Customer Job Number: Project P.O. Number: PO REOUIRFD Delivery Instructions: WATER FIDDED Dv J06 SUPER ONL;'I I I ak'�jr1 (z 11S OA Ae y Order Code I Data: E1 J8 10/27 /15 Order P.O. Number:. 454195070 Map Page: MaplRovdColumn: I Dispatcher: dR'r j(Q, J rlebol--bp r,e " Ticket Number: i 34U18448 Due On Job: Slump: Truck Number: Driver Number.' Driver Name: End Use: 12: 5. oO 10o2 48'78 1 u9513 ANTHONY KELLY 111._DNr: HALL LOAD CUMULATIVE I ORDERED rytATERIAL CODE PRODUCTION DESCRIPTION UOM UNIT PRICE. AMOUNT QUANTITY QUANTITY QUANTITY - ' 1p. f7t? 4t7„ 1{r c<7. t?t? Irrr1173r 3000 DLENDEDPRPM 1.00 124.7810 FUEL SURCHARGE OICT 27 114 t.00 Ccsir749 ENVIRONMENTAL. CHARGE Cash CheckklAuth Cotle:. Signature of Driver Receiving Cash: Cash Recalved: Total COD Order Amount to Collect. Without Standby Charges: 'Check Charge Comments: WATERADDED: GAL YARDS IN DRUM: 1. WHEN ADDED. e / SIGNATURE / CURB LINE CROSSED AT OWNER'S/AGENT'S REQUEST: CONCRETE DISP iAL FEE_ SIGNATURE PARTIAL FULL. LOAD `LARDS ❑LOAD WAS TESTED BY:. 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 responsiblllty 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 saleand 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. Nocreditfcr safety handling information, and to the material safety data sheets for addillonal Information. returned concrete. Buyers exceptions and claimsshallbe deemed waived unless made to us In writing AUTHORIZED SIGNATURE: within one business day after the receipt of materials. 0 68UNIVERSAL PRE.V TRK: _ INVOICE LOAD NUN: 1 This Delivery Ticket incorporates herein by reference Buyer's previously executed Credit Application, if any, Seller's Standard Terms and Conditions, Seller's Quota if any, and Seller's Order Confirmation luding limitations of warranties), ag f-Py set forth on this Delivery Ticket (`Ag lent"). Seller will provide the Standard T 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. AUUKEliA'1'E / C;EMEN'1' / U01NUKE'1'E FRODUU'1'S / N'LY 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 arnmo- ❑ia. 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.cemexusa.com, Este ticket de entrega incluye comp referencia al comprador (ya previamente ejecutada en su aplicaci6n de cr6dito); cualquier te'rmino estandar, condiciones del vendedor, propuestas del vendedor y Orden de confirmaci6n del vendedor (con limitaciones y garantfas), Como acuerdo total del ticket de entrega ("Contrato '). El vendedor proveerd los t6rminos est tndares y condiciones detal- iados en caso de asf ser requeridos. Con este documento, el comprador acepta los mismos ya antes mencionados y quo las cantidades y materiales fueron entregados como se expresa on el mismo. Acepta pagar cl monto de acuerdo al contacto; al menos quo se identi- fique con una rota al frente de este documento. lih 1rL�� rI:A� � U67 Los productos de agregados son materiales naturally como piedra caliza, dolomita, granito, rota volcdnica, 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 volcinica, arena, grava, y otros materiales silicios. Estos productos incluyen cenizas volantes (fly ash) la coal puede contener mds de 0.025% de silicio cristalino. PeRgros: Mezcla de cemento fresco y/o cenizas volantes pueden causar irritaci6n en los Ojos, quemaduras en piel y Ojos, y reacciones alergicas en la piel. Concreto seco y polvo de agregados, pueden causar'irritaci6n en los Ojos, pie] y/o on la zona respiratoria. Polvo del manejo en el trituramiento, pulido, Corte 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 cdlida, reposar y tomar grandes cantidades de agua. Las cenizas volantes pueden contener amoniaco. Seguridad: La humedad puede causar la liberaci6n del amoniaco. La inhalation del amoniaco puede causar toser, irritaci6n o quemaduras en la nariz, garganta y pulmones. Acudir inmediatamente al medico. El riesgo on la salud depende oil la duraci6n y el nivel de la exposici6n. Seguridad: Evite el contacto con Ojos y contacto prolongado con ]a piel. Use guantes, protecci6n on los Ojos y ropa Primeros adecuada para protecci6n. Ldvese las matins con jab6n suave y agua despu6s del manejo de materiales. Evite inhalar auxilios: polvos. Si se expone a polvos mds de los limites recomendados, use protecci6n respiratoria. Primeros auxilios: En caso de contacto on Ins Ojos, inmediatamente fluya agua en la pane afectada per 15 minutos. Si se inhala polvo, exp6ngase a aire fresco. Si el cemento fresco tiene contacto con sus Ojos, Idvelos a fordo con agua. Acuda a atenci6n medica inmediatamente si la irritation continda. CEMEX, Memorial Hermann Tower 929 Gessner, Suite 1900 V7 combinado Houston, Texas 77024 02/12 Para mds informaci6n visita www.cernexusa.com. r ZCMMC-X SLC.- I S 05 - OZ-9 7 1 I 58268280 Plant' .,. .. q��"^.Beg�n�L?`oading:`y " Toob: .,.,�........,,�. Aivob Start Unload: F,Inish Unload;. ' Leave Jo, : Return Plant: i t' L1'�i:r 1U':ic rC^�ustomer Code: (C�!usstomer rN�apme:. 71PioJ'ec26 d.!. Q F-jio��7.st:Na�Rr559:aSrRUCTION SERVICF„J�' L.LC 4 T'Icke��oate:J'S?� �� D81Ivim}AddrttT1N THRU VERO . 11 &1v ry{'nstri"a is.. TARPON FLATS LOT 19 WATER ADDED E�Y -10B SUPER ONLY! f ? Customer Jab Number:. 'Project P.O,. Numbers PO REGU I RED Ordettr Code / Date: Rd' P.O. Number^{ f c 7/ 1 J Map P6ge:" ap/ ow1Column: Dispatcher:.cry{ TIcKe1T�5m6Af "D. _ it Due On Job: Slump: Truck Number: Driver Number. Driver Name: - Ehtl Use: n LOAD CUMULATIVE ORDERED MATERIALCODE PRODUCTIONDESCRIPTION UOM UNIT PRICE AMOUNT QUANTITY QUANTITY QUANTITY 1t1, qG 2't7. GO 20. [)t] 1} 09,405 3000 SLENDEDPRPM vD 1.00 124-78tg FUEL. SURCHARGE 1.Uo 12K)8749 ENVIRONMENTAL CHARGE 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. CURB LINE CROSSED AT OWNER'S/AGENT'S REQUEST: JONCRETE DISPOSAL FEE - PARTIAL FULL LOAD -- YARDS SIGNATURE ❑ LOAD WAS TESTED BY: Notice: Our drivers will make every effort to place matedals 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 hadardous to your safety and health. Please refer to the backside of this ticket for Important)1 control after delivery, this Company wilt not accept any responsibility for the finished results. No credit for safety handling Information, and to the material safety data sheets for additional Information. 1 returned Concrete. Buyers exceptions and: claims shall be deemed waived unless made to us In writing AUTHORIZED SIGNATURE: within one business day after the recelpt of materials. PREV TRK. 10(124878 68UNIVERSAL INVOICE This Delivery Ticket incorporates her )y reference Buyer's previously executer r"—dit Application, if any, Seller's Standard, Terms and Conditions, Seller's Quotal if any, and Seller's Order Confirmation uding limitations of warranties),a - fully set forth on this Delivery Ticket ("Agreement"). Seller will provide the Standard Tereus 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 bums 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 www.ccmexusa.com. Este ticket de entrega incluye como referencia al comprador (ya previamente ejecutada en su aplicaci6n de cr6dito); cualquier termino estandar, condiciones del vendedor, propuestas del vendedor y orden de confinnaci6n del vendedor (con limitaciones y garantias), como 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 documento, el comprador acepta los mismos ya antes mencionados y que las cantidades y materiales fucron 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. Vh UUN UKh 1'U / ULINIZAa VULAIN'1'EJ Los productos de agregados son materiales naturaley como piedra caliza, dolomita, granito, roca volcanica, arena, grava y otros materiales silicios. Los productos de cemento incluyen Cemento de tipo Portland, de albanilerfa, pozzol<ur (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. Estes 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 reacciones aldrgicas en la piel. Concrete, 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, corte'y/o perforaci6n puede contener materiales silicos, Jos 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 liberacion del amoniaco. La inhalaci6n del amoniaco puede causar toser, irritaci6n o quemaduras en la nariz, garganta y pulmones. Acudir inrnediatamcnte 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 los ojos y ropa Primeros adecuada para protecci6n. Lavese las manor con jab6n suave y agua despuds del manejo de materiales. Evite inhalar auxilios: pelves: 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 fondo con agua. Acuda a atenci6n medica imnediatamente si la irritaci6n continua. CEMEX, Memorial Hermann Tower 929 Gessner, Suite 1900 V7 combinado Houston, Texas 77024 02/12 Para mas informaci6n visita www.ce a� zzcmcx SLC- 1 SUS' - vz8'7 LO 1 Begm Loading ,'Vt�To" Job,wg ArrivevJob ya ;.Stan Unload wish U!—!!7, iljwgm Return'Plant y`" : r I. ... _ Customer Code: Customer Name: -N 2WSI P[oc:cjecLCode:)�45 CONSTRUCTION SERVICES LLC UProject Name: 4-10o2580 MAT -MARTIN THRU VERO Ticket Date DeliveryAddress: 10./27/15._ TARPON RLA-r9 LPT 19 Delivery Instrucdcns:, WATER ADDED &-Y .1:013 SUPER ONLY! 1 ! Customer Job Number: Project P.O. Number: PO REQUIRED Order Cade / Date: at78- 10/27J15 `Order P.O.:Number. 454195070 Map Page: Map/Row/Column: Dispatcher. rota in I Ticket Number. i 34111.U9.9 Due On Job: Slump: Truck Number: Driver Number: Driver Name: .End Use; • dr. r.. I it i t t"fl'7' 4,A7!-1 tits# �'I "? i' I- JY v n y - LOAD CUMULATIVE i ORDERED MATERIALCODE PRODUCTION' DESCRIPTION QUANTITY QUANTITY I QUANTITY' 7.00 ' P-7.00 27.01:+ 1509`-395 wr00o BLENDEDPRFM f.,.00 1,847815 FUEL SURCHARGE 1.00 1202749 ENVIRONMENTAL CHARGE .RI nnlr • L.I. I .L.. UOM 'UNITPRICE 7 AMOUNT YD3 OCT 27 PM 2. 38 Cash Check #/Amin Code: Signature of. Dever Receiving Cash: Cash R... ved: Total conomer Amounitaconect .rd ' Without Standby Charges: Check Charge - - - Comments: WATERADDED: GAL YARDS IN DRUM: WHEN ADDED. SIGNATURE CURB LINE CROSSED AT OWNER'SIAGENT'S REQUEST: ONCRETE DISPOSAL"FEE SIGNATURE PARTIAL _ FULL LOAD YARDS Q LOAD WAS TESTED BY:, 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 lohgerguaranteed. 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. Nocredilfor 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 to. us In writing AUTHORIZED SIGNATURE: within one business dayafter the receipt of materials. 68UNIVERSAL PREV TRK: 10022539 INVOICE LOAD NUM: 3 \ This Delivery Ticket incorporates hen y reference Buyer's previously executers r —dit Application, if any, Seller's Standard Terms and Conditions, Seller's Quotat if any, and Seller's Order Confirmation ( iding limitations of warranties), i, fitfully set forth on this Delivery Ticket ("Agreement"). Seller will provide the Standard Tei un 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 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 www.cemcxusa:com. Este ticket de entrega incluye como referencia al comprador (ya previamente ejecutada en su aplicaci6n de cr6dito); cualquier t6rmino estandar, condiciones del vendedor, propuestas del vendedor y orden de confirmaci6n del vendedor (con limitaciones y garantfas), como acuerdo total del ticket de entrega ("Contrato"). El vendedor proveera Ins terminos estandares y condiciones detal- lados en caso de asf set requeridos. Con estedocumento, el comprador acepta los mismos ya antes mencionados y que las cantidades y materiales fueron entregados como se expresa on el mismo. Acepta pagar el monto de acuerdo al Contrato; al menos quo se identi- fique con una rota al frente de este documento. DE CONCRETO / CENIZAS VOLANTES Los productos de agregados son materiales naturally como piedra caliza, dolomita, granito, rota volcinica, 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, grainto, rota volddnica, arena, grava, y otros materiales silicios. Estos productos incluyen cenizas volantes (fly ash) la cual puede contener mds de 0.025% de silicio cristalino. Peligros: Mezcla de cemento fresco y/o cenizas volantes pueden causar irritaci6n en los ojos, quemaduras en piel y ojos, y reacciones alergicas en la piel. Concreto seco y polvo de agregados, pueden causar irritaci6n en los ojos, pie] y/o en la zona respiratoria. Polvo del manejo on el trituramiento, pulido, Corte 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 ]a liberaci6n del amoniaco. La inhalaci6n del amoniaco puede causar toser, irritaci6n o quemaduras en la nariz, garganta y pulmones. Acudir inmediatamente a] medico. El riesgo on 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 on los ojos y ropa Primeros adecuada para protecci6n. Ldvese las matins con jab6n suave y agua despubs del manejo de materiales. Evite inhalar auxilios: polvos. Si se expone a polvos m'as de los limiter recomendados, use protecci6n respiratoria. Primeros auxilios: En caso de contacto on Ins ojos, inmediatamente fluya agua on la parte afectada pot 15 minutos. Si se inhala polvo, exp6ngase a sire fresco. Si el cemento fresco tiene contacto con sus ojos, l5velos 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 informati6n visita www.ce MEMEX 5853*.504 RECEIVED DEC 024 Plant: Begin Loading: - To Job: Arrive Job:: Start Unload: Finish Unload:. - Leave Job: Riotum Plant: Customer Code: Customer Name: '- , Customer Job Namberl� Order Code/.Date: 'Project Code: Project Name: Project P.O. Number. Order P.O_. Number. Ticket Date: Delivery Address: Map Page: MaplRow/Column: Delivery Instructions;: Dispatcher: -'i. '}.. Ticket Number Due On Job: .Slump: Tmtk Numbar. Driver Number. DriverName: -' Ena Use: ^ - 1''F:"C.,? .1 _ill.11. i'4ti�_1�{'�i_ LCi\�IJ: trF11 LOAD. CUMULATIVE ORDERED NIATERIALCODE PRODUCTION DESCRIPTION ". UOM', UNITPRICE AMOUNT QUANTITY QUANTITY QUANTITY - - - . ..;f r. V7 RrN., 'ENI r4l I € 4Fft�C 4 Cash Check # /Auth Code: I Signature of Driver Receiving Cash: I CashReceived::. '' ' d f' t•" '+WATERADDED: 'r 7 GAL. " YARDS^IN DRUM:'• WHEN ADDED. SIGNATURE CURB LINE CROSSED AT OWNER'S/AGENT'S REQUEST: T SIGNATURE ❑ LOAD WAS TESTED BY: - Notice: Our enters will make every effort toplace mandate where the customer designates, but the SPECIALTERMS: Any water added Ispa customers am ask. lfwaler lsadded on job, conerete 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 safely5hd 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 safely handling,Information and to the material safety data sheets for additional Information. returned concrete. Buyers exceptions and claims 'shall be deemed walved unless made to us In writing AUTHORIZED SIGNATURE: within one business day after the recelpt of materials. 68UNIVERSAL CUSTOMER This Delivery Ticket incorpornt—, herein by reference Buyer's previously ^cuted Credit Application, if any, Setter's Stan Terms and Conditions, Seller rotation, if any, and Seller's Order Conft ion (including limitations of warrpaC. •s,.,as it fu set forth on this Delivery Tick_ , Agreement"). Seller will provide the Stinuaid Terms and Conditions upon reque.,t. Buyer w, that, unless otherwise. noted on the front hereof, all quantities and items were delivered as indicated and further exlscs,'y agn. to pay in accgrdance,w th_tke Agreement. AGGREGATE / CEMENT / CONCRETE PRODUCTS / FLY ASH Aggregate products are naturally occurring materials including limestone. dolomite, granite, volcanic rock, sand, gravel, and. uJiL siliceous materials. Cement products include Portland cement, masonry, pozzolan (Type IP), rgof tile, and stucco. Concrete products in 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 ashcan 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,'euttang and/or drilling may contain silica, which may cause silicosis e,rd cancer it whaled: If ingested keep warm, at rest, and drink large amounts of water. Fly.Ash may contain tea e.--mounts of c_nmo- 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.cemexusa.com. Este ticket de entrega incluye como referencia al cornprador (ya previamente ejecutada en su aplicaci6n de creclito): cualquier tdrmino estandar, condiciones del'vendedor, propuestas del vendedor y order de confirmaci6n del vendedor (con limitaciones y garantfas), comp acuerdo total del ticket de entrega ("Contrato"). El vendedor proveera.los terminw estandares y condiciones detal- lados en caso de asf set requeridos. Con este documento, el compradoracepta los mismos ya antes rnenclonados y que las canticdades y materiales fueron entregados cot -no se expresa on el mismo. Acepta pagar el monto de acuerdo at contrcto; ,it mcnos que se identi figne con una nota at frente de,este documento. DE CONCRETO / CENIZAS Los productosde agregados son materiales naturaley como piedra caliza, dolomita, granito, coca volcanica, arena, gravy 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, roca volcanica, arena, grava, y otros materiales silicios. Estos productos incluyen cenizas volantes (fly ash) la coal puede contener mas de 0.025% de silicio cristalino. Peligros: Mezela de cementO fresco y/o cenizas volantes pueden causar irtitaci6n en los Ojos, quemaduras en piel y Ojos, y, reacciones al6rgicas on la pieL Concreto seco y polvo de agregados, pueden causar irritaci6n on los Ojos, piel y/o on lee zona respiratoria. Polvo del manejo on el trituramiento, pulido, corte,y/o perforaci6n puede contener materiales silicos, Ins cuales pueden causar silicosis pulmonar y cancer si son inhalados. En caso de set ingeridos. manteaerse en temperatura calida, reposar y tomar grandes cantidades de agua. Las cenizas volantes pueden contener anioniaco. Seguridad., La humedad puede causar la liberaci6n del anioniaco. La inhalaci6n del anioniaco puede causar toser, trritaci6n o quemaduras en la nariz, garganta y pulmone.s. Acudir inmediatamente al medico. El riesgo on la salud depende on la duraci6n y el nivel de la exposici6n. Seguridad: Evite el contacto con ojos y contacto prolongado con la piel. Use guantes, protecci611 en los ojos y ropa Pkimeros adecuada para protecci6n. Lavese las mans con jab6a suave y agua despu6s' del manejo de materiales. Evite inhalar atxilios: polvos., Si so expone a polvos mas deIns limites recomendados, use protecti6n respiratoria. Primeros auxilios: En caso de contacto en Ins ojos, inmediatamente fluya agua en la pane afectada por 15 minutes. 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 m6dica inmediatamente si la irritation continua. CEMEX, Memorial Hermann Tower 929 Gessner, Suite 1900 V7 combinado Houston, Texas 77024 02/12 Para mas informaci611 visita www.ce 016 7zc E M E X �l _ t 5858 507 Plant: Begin Loading: To Job: Arrive Job: StartUnload: Finish Unload: Leave Job: Return Planti Customer Code: Customer, Name: (;f tC:fi]P:S Fl)I TTa:„ :I YIIF'Z I I r Project Code: ' Project Name: t1 Ticket Data: Delivery Address:. Delivery Instructions: ,. ?; i �l;CI ', `,Y'=i•, i " f-,t\{l.: _fi 't,� ;.1.1"„' f7•, Customer Job Number. Order Code I Data Project P.O. Number.. Order P.O. Number: Map Page; MaplRowlColumn: Dispatcher: Ticket Number: ..14.(17E''?`i i Due On Job: Slump:, TruckNumber.. Driver Number. Driver Name: End Use: FF`- Dj-:f T _;' RLI)f Jt tdflt .; ,LOAD CUMULATIVE OROEREO. MATERIAL CODE PRODUCTION DESCRIPTION UOM UNIT PRICE AMOUNT QUANTITY QUANTITY QUANTITY - XTotal COD Order Amount io hout atandby Charges: Comments: " V WATER ADDED: GAL YARDS IN DRUW WHEN: ADDED.. SIGNATURE Po r'ja �� CURB LINE CROSSED AT OWNER'S/AGENT'S REQUEST: I' ('If>-1- TIFIL FULL Lctfx1 _.. 'rpq 1'i.i)S ffll" SIGNATURES ,❑, LOAD WAS TESTED BY:�/ 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 cure or property line. Customer agrees. to the is no longer guaranteed. WARNING: Product may cause skin andlor eye Inflation. CAUTION: Material terms of sale and delivery and accepts concrete as, is Due to important factors whichare out of our .maybe 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 infannatlen, and to the material safety data sheets for additional information: retumedrooncrete. Buyersexceptions and claims shall be deemed waived unless made to us to writing. AUTHORIZES SIGNATURE' within one business day after the receipt of materials OFF -;a eCJ(iD 1t'f?fl: s6UNIVERSAL CUSTOMER This Delivery Ticket incorporates herein by reference Buyer's previously ,uted Credit .Application, if any, Seller'sStandard Terms and Conditions, Seller rotation, if any, and Seller's Order Confi ion (including limitations of warripties), jis if fully set forth on this Delivery Tick... Agreement"). Seller will provide the Stai,..d 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%n 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 (lust. If exposed to dust above recommended limits (see IVISDS), wear suitable NIOSH-approved respiratory protection. IF, Aid: In case of eye contact, immediately flush eyes with flowing water for 1.5 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.ccmexusa cgm. Este ticket de entrega incluye como referencia al comprador (ya previamente ejecutada en su aplicacion de credito): cualquicr tdrmino estandar, conditions del vendedor, propuestas del vendedor y orden de confirmation del vendedor (con lirnitaciones y garantfas), como acuerdo total del ticket de entrega ("Contrato"). El vendedor proveerd-los terniinos estandares y condiciones detal- lados en caso de asf ser requeridos. Con este documento, el comprador acepta los mismos ya antes mencionados y que ]as cantidades y materiales fueron entregados',como se expresa en el mismo. Acepta pagar el monto de acuerdo al contrcto; al menos que se identi- fique con unanota al frente de este documento. AGREGADOS/CEMENTO/PRODUCTOSDE Los productos de agregados son materiales naturales como piedra caliza, dolomita, granito, coca volcdnica, 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,roea volchnica, arena, grava, y otros materiales silicios. Estos'productos incluyen cenizas volantes (fly ash) la cual puede contener m is de 0.025%v 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. Concretoseco y polvo de agregados, pueden causar irritation en los Ojos, piel y/o en la zona respiratoria. Polvo del manejo en el trimramiento, pulido, cone 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: 'Lwhumedad puede causar la liberaci6n del amoniaco:La inhalaci6n del anioniaco'puede causar toser, initaci6n o qucmaduras on la nariz, garganta y'pulmones, Acudir inmediatamente al medico. El riesgo on la salud depende err la duraci6n 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. Ldvese las mans con iab6n suave y agaa despues del manejo de materiales. Evite inhalar auxilios: polvos. Si se expone a polvos mds de los limites recomendados, use protecci6n respiratoria. Primeros auxilios: En caso do contacto en los ojos, inmediatamente fluya agua en la parte afectadapor 15 minutos. 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 i ritaci6n contintia. CEMEX, Memorial Hermann Tower 929 Gessner; Suite 1900 V7 combinado Houston, Texas 77024 02/12 Para mas informaci6n visita www,cei