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Plant: Begin Loading: To Job. Arrive Job: Start Unload: Finish Unload: Leave Job: Return Plant;
Customer Code: Customer Name: Customer Job Number: Order Code!Date: _ 1.r
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Project Code: Project Name: Project P.O.Number. YY Order P.O.Number:
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Ticket Date: _ Delivery Address: s Ma2Page:._ Map/R
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Delivery Instructions: Dispatcher
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Ticket Number!,
Due On,Job: Slump: TruckJ{umbe� Driver}Number: +A iver.Name'_ End Use'
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LOAD CUMULATIVE ORDERED
QUANTITY QUANTITY QUANTITY MATERIAL CODE PRODUCTION DESCRIPTION UOM UNIT PRICE AMOUNT
i_' 49 310C,C-11 kEtr'.: i`-:_BER M0N0.._i' 3.B : D.:;
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Cash Check#/Auth Code: Signature of Driver Receiving Cash: Cash Received: Total COD Order Amount to Collect
1 Check Without Standby Charges:
Charge
Comments:Comments:
I WATER ADDED: GAL YARDS IN DRUM:
WHEN ADDED.
/ SIGNATURE
e r,- r-1- CURB LINE (rOSSEDAJT>-01A1, NER'S/ArGECI rS REQUEST:
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LY_.--'SIGNATURE
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LI LOAD WAS TESTED BY.
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'-Notice: Our drivers will make every effort to place materials where the customer designates,but the SPECIAL TERMS: Any water added is at custorDets own risk. If water is added on job,concrete strength
Company assumes no responsibility for damages inside curb or property line. Customer agrees to the is no longer guaranteed. WARNING: Product may cause skin and/or eye irritation. CAUTION: Material
terms of sale and delivery and accepts concrete as is. Due to important factors which are out of our may be hazardous to your safety and health. Please refer to the backside of this ticket for important
control after delivery,this Company will not accept any responsibility for the finished results. 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
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68UNIVERSAL INVOICE
This Deliv,.•ry� 'Picket into. tres aerjM by r .:n'
e� t-�Ce Buyer's previoi, executed Credit Application, if any, Seller's Standard
Terns and Conditions,Sel Quotation,if any,and Seller's Order Confirmation (including limitations of warranties), as if i'ully
set forth on this Delivery Ticket("Agreement").Seller will provide the Standard Terms and Conditions upon request. Buyer agrees r?
that,Lidless otherwise noted on the front hereof,all quantities and items were delivered as indicated and further expressly agrees to r
pay in accordance with the Agreement. L
AGGREGATE / CEMENT / CONCRETE PRODUCTS / S'L'Y ASH
Aggregate products are naturally occurring materials including limesionc;.dolomite,granite,volcanic rock,sand,gravel,and other 1
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 1
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.
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'Safety: Avoid contact with eyes and prolonged contact with skin.Wear gloves,eye protection,and appropriate protective
clothing. Wash hands thoroughly with mild soap and water after handling. Avoid breathing dust. If exposed to
dust above recommended limits (see MSDS),wear suitable NIOSH-approved respiratory protection.
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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.corn.
Este ticket de eutrega i.ncluye tomo referencia al. comprador (ya pieviamente ejecutada en su aplicaci6n. de Credito); cualquier i
termino 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 terminos estandares y condiciones detal-
lados en vaso 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 elmismo.Acepta pagar el monto de acuerdo al Contrato; al menos que se ident.i-
fique con una nota al frente de este documento.
AGREGADOS / CEMENTO / PRODUCTOS DE CONCRETO / CENIZAS VOLANTES
Los productos de agregados son materiales naturales como piedra caliza,dolomita, granito, roca volcanica, arena, grava y otros
materiales silicios. Los productos de cemento incluyen Cemento de tipo Portland, de albanilerfa, pozzolan (tipo IP), azulejo de
azotea y estuco. Los productos de concreto incluyen cemento Portland y productos de agregados como piedra caliza, dolomita, I
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.
-CUIDADO!
Peligros: Mezcla de cemento fresco y/o cen.izas 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 respirator.ia.Polvo del.manejo en el trituramiento,pulido,torte y/o per.-foraci6n puede contener materiales
silicon,los cuales pueden causar silicosis pulmonar y cancer s.i son inhalados. En caso de ser ingeridos,mantenerse
en temperatura calida,reposar y tornar grandes cantidades de agua.Las cenizas volantes pueden contener amoniaco.
Seguridad: La humedad puede causar la liberaci.6n del amoniaco. La inhalaci6n del amoniaco puede causar toser, irritaci6n o
quemaduras en la nariz,Barg mta y pulmones.Acudir.inmediatamente al medico. El.riesgo en la salud depende en
la duraci6n y el nivel de la exposici6n.
Seguridad: Evite el.contacto con Ojos y contacto p.rolongado 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
auxilios: polvos. Si se expone a polvos mas de los limites recomendados,use protecci6n respiratoria.
Primeros auxilios: En caso de contacto en los ojos,i.nmed.iatam.ente 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 inmediatamente si la irritaci6n continua.
CEMEX,Memorial.Hermann Tower
929 Gessner,Suite 1900
V7 combinado Houston,Texas 77024
02/12 Para mas informaci6n visit.a www.cernexusa.com.